Optimal Blood Glucose Control Research Articles

Prevalence and determinants of poor glycaemic control in individuals aged between 18-60 years, at a regional hospital in KwaZulu-Natal Province, South Africa- a cross sectional study.

Achieving optimal blood glucose control is imperative for preventing diabetes related complications and negative socio-economic consequences associated with them. The aim of the study was to determine the prevalence and determinants of poor glycaemic control amongst type II diabetic outpatients presenting at a regional semi-rural hospital in eThekwini district, Kwa-Zulu Natal. An observational, analytic cross-sectional study was conducted amongst 384 systematically sampled type 2 diabetes patients. Data were collected by an interviewer administered questionnaire, clinical record review and anthropometric measurements. Bivariate and multivariate analyses were performed. Ninety one percent of the study population (349/384) had poorly controlled diabetes. Amongst uncontrolled diabetics, 80% (n=281) were older than 35 years' age group; 58% (n= 203) were male; 85% (n=295) completed primary school education and 93% (n=324) were overweight. Patients that were 35 years and older, female, employed, had a high body mass index, were on oral hypoglycaemic and/or insulin in combination, and receiving treatment longer than 3 years, had an increased odd of uncontrolled diabetes. Being female and receiving oral hypoglycaemic and/or insulin were significantly associated with poor blood glucose control. Patient that were female overweight, having a lower level of education, and greater than three-year duration of medication and on oral hypoglycaemic agent and/or insulin were more likely to have poor blood glucose control. These factors should serve as early identifiers of potential poor control and an alert clinician to adopt a more active approach to optimize treatment.

Investigating the Impact of Multiple Inputs on Predicting Glucose Level in Individuals with Type-1 Diabetes through Deep Learning Technique

Type-1 Diabetes is a chronic auto-immune disorder featured by the disability of human body to produce insulin, an enzyme helps to digest carbohydrates. Insulin works with the take-up of glucose from the circulatory system into cells. Without sufficient insulin, glucose aggregates in the blood, prompting hyperglycemia. Uncontrolled hyperglycemia, whenever left untreated, can bring about dangerous intricacies, which can harm the vital organs. Managing type-1 diabetes presents huge difficulties for impacted people, as it requires a sensitive equilibrium of insulin administration, sugar consumption, active work, and cautious observing of blood glucose levels. Despite the progress made in type-I diabetes management, challenges persist. Achieving optimal blood glucose control remains elusive for many individuals. Understanding the complex interplay between these variables and their impact on blood glucose regulation is vital for emerging more effective treatment strategies.
 Accurate and timely prediction of glucose level plays a critical role in the effective management of diabetes. Through this paper we aim at investigating the impact of multiple inputs on forecasting of glucose level in individuals with type-1 diabetes by means of deep learning techniques. In our paper, we use the Long-Short-Term-Memory (LSTM) network to study the forthcoming blood glucose pattern when various combinations if inputs, previous blood glucose reading, insulin administrated and carbohydrate intake are provided as inputs. We used the ShanghaiT1DM dataset for the study.

Key Nutrients for Optimal Blood Glucose Control and Mental Health in Individuals with Diabetes: A Review of the Evidence.

Diabetes is associated with an increased risk of mental disorders, including depression, anxiety, and cognitive decline. Mental disorders can also contribute to the development of diabetes through various mechanisms including increased stress, poor self-care behaviors, and adverse effects on glucose metabolism. Consequently, individuals suffering from either of these conditions frequently experience comorbidity with the other. Nutrition plays an important role in both diabetes and mental health disorders including depression and anxiety. Deficiencies in specific nutrients such as omega-3 fatty acids, vitamin D, B vitamins, zinc, chromium, magnesium, and selenium have been implicated in the pathogenesis of both diabetes and mental disorders. While the impact of nutrition on the progression and control of diabetes and mental disorders is broadly acknowledged, there is a notable knowledge gap concerning the implications of distinct nutrients in preventing and mitigating symptoms of both conditions when they coexist. The aim of this study was to examine the role of nutrition in improving glucose homeostasis and promoting mental well-being among individuals with diabetes. Further, we evaluated the preventive or delaying effects of key nutrients on the simultaneous manifestation of these conditions when one of them is present. Our findings indicated that the use of personalized dietary interventions and targeted nutrient supplementation can improve metabolic and mental health outcomes in patients with type 2 diabetes.

The effect of menstrual hormonal fluctuations on the glycaemic control in women with type 1 diabetes mellitus

Abstract Information on physiological processes that affect insulin action and glycaemia is of paramount importance in the treatment of type 1 diabetes mellitus because optimal blood glucose control can prevent or decelerate microvascular complications. In insulin‐deficient premenopausal women, sensitivity to exogenous insulin seems to be lower during ovulation and in the luteal phase compared to the follicular phase. This difference directly affects glucose management. The risk for hyperglycaemia is oftentimes higher in the second half of the catamenial cycle, while hypoglycaemic events may occur more often in the follicular phase. Ovarian steroids (oestradiol and progesterone) are probable modulating factors in insulin action. Rising oestradiol during midcycle and high progesterone in the secretory phase of the menstrual cycle may contribute to insulin resistance. The underlying physiological mechanisms are largely unknown. It is possible that progesterone enhances gluconeogenesis in the liver and oestradiol binds to insulin and its receptor, thereby increasing resistance to insulin. These actions remain to be clarified. Additional factors related to the catamenial cycle may also facilitate variability in insulin sensitivity. The presence of glycaemic changes during the menstrual cycle is not consistent among premenopausal women with type 1 diabetes. The variability of blood glucose throughout the menstrual cycle should be considered when adjusting insulin dosage in susceptible subjects. Copyright © 2023 John Wiley & Sons.

1498-P: Preemptive Insulin Supplementation for Islet Graft Protection, Optimal Blood Glucose Control, and Fetal Development during the Pregnancy in Insulin-Independent Patient after Islet Transplantation

Pregnancy increases metabolic demand for insulin, which may lead to the exhaustion of intraportally transplanted islets and postgestational hyperglycemia. Here we report a successful long-term preservation of islet graft function after two subsequent pregnancies while applying preemptive insulin supplementation. 29-year-old female with T1DM achieved long-term insulin independence with HbA1c <5.8% after a single intraportal islet transplant. Before conception, mycophenolate was replaced with azathioprine and tacrolimus target trough level was decreased to 4-6ng/ml. The patient became pregnant twice, 5 years and 7.5 years after her islet transplantation. During the first and second pregnancy patient preemptively supplemented with insulin up to 35-70u/day and up to 35 units daily, respectively to target fasting blood glucose below 90mg/ml. Postpartum the patient was successfully weaned off insulin maintaining optimal blood glucose control with HbA1c below 5.7%. Islet graft function before and after the pregnancy remained optimal as reflected by BETA-2 above 17 and comparable c-peptide secretion and peak blood glucose levels below 130mg/ml during the 8.5-year follow-up in Mixed Meal Tolerance Test. Both newborns were premature and delivered at 34 weeks with emergent c-sections due to preeclampsia. Unfortunately, the first newborn died due to necrotizing enterocolitis. The second child has been developing appropriately up-to-date three months after her birth. Our report confirms that insulin supplementation during pregnancy in insulin-independent patients after islet transplantation was safe and effective in maintaining optimal blood glucose control and islet graft function in the long term. It also underscores the high-risk nature of pregnancy in islet transplant recipients and the need for close clinical monitoring. Disclosure S.Gondek: None. L.Wang: None. M.Tibudan: None. R.Barth: None. J.Fung: None. P.Witkowski: Advisory Panel; Vertex Pharmaceuticals Incorporated, Novartis. M.Ogledzinski: None. W.Lin: None. K.Milejczyk: None. B.Juengel: None. L.Potter: None. P.J.Bachul: None. L.Basto: None. L.Perea: None.

Persistence of long-term insulin independence after islet transplantation and two subsequent pregnancies.

Pregnancy increases metabolic demand for insulin and may lead to the exhaustion of intraportally transplanted islets and post-gestational hyperglycemia. To prevent these complications, we implemented preemptive insulin supplementation during two subsequent pregnancies in an insulin-independent islet transplant recipient. This strategy resulted in optimal blood glucose control during the pregnancies, the preservation of the optimal islet graft function and the postpartum maintenance of long-term insulin independence.

Determinants of blood pressure and blood glucose control in patients with co-morbid hypertension and type 2 diabetes mellitus in Ghana: A hospital-based cross-sectional study.

Hypertension and diabetes are major risk factors for cardiovascular diseases and optimal control of blood pressure (BP) and blood glucose are associated with reduced cardiovascular disease events. This study, therefore, sought to estimate the prevalence and associated factors of controlled BP and blood glucose levels among patients diagnosed with both hypertension and Type 2- diabetes mellitus (T2DM). A quantitative cross-sectional study was conducted in a primary health setting in Ghana among patients 18 years and older diagnosed with both hypertension and T2DM. Pearson's chi-square was used to assess the association between BP and blood glucose levels and the independent variables. The multivariable binary logistic regression model was used to assess the adjusted odds of controlled BP and blood glucose levels. Among the 329 participants diagnosed with both hypertension and T2DM, 41.3% (95% CI: 36.1-46.8%) had controlled BP, 57.1% (95% CI: 51.7-62.4%) had controlled blood glucose whilst 21.8% (95% CI: 17.7-26.7%) had both controlled BP and blood glucose levels. Increased age, non-formal education, non-married, employed, single-dose anti-hypertensives or anti-diabetic medications, and hyperlipidaemia or stroke co-morbidities were positively associated with controlled BP levels. Being female, married, taking 2 or more anti-hypertensive medications, and moderate to high medication-related burden were positively associated with controlled blood glucose levels. In terms of both controlled BP and blood glucose levels, being employed, reduced income level, being registered with national health insurance, single anti-diabetes or anti-hypertensive medications, hyperlipidaemia or stroke co-morbidities, and moderate to high medication-related burden were positively associated with having both controlled BP and blood glucose levels. One in five patients with hypertension and T2DM had both BP and blood glucose levels under control. The benefits and risks of blood pressure and blood glucose targets should thus be factored into the management of patients with hypertension and T2DM.

PSUN280 A Rare Genetic Disorder With Recurrent Hypoglycemic Episodes and Ketonemia Requiring Multidisciplinary Team Management During Pregnancy

Abstract Introduction Beckwith-Wiedemann syndrome (BWS; OMIM 130650) is a multisystem human genomic imprinting disorder of chromosome 11p15.5. It is characterized by overgrowth and cancer susceptibility and is known to have a highly variable clinical spectrum. The main features include lateralized overgrowth and hypoglycemia due to prolonged hyperinsulinism. Most case reports on BWS are focused on the pediatric population with very scarce data in adults. Clinical case A 29-year-old, paralympic swimmer and genetically diagnosed female with BWS had recurrent episodes of hypoglycemia during her second pregnancy. She had a history of six previous first trimester miscarriages, anti-phospholipid syndrome, hypoglycaemic seizures, asthma, and migraines. Pre-pregnancy, she was investigated for a neurological cause of her seizures and an electroencephalogram and brain imaging were unremarkable. She underwent extensive investigations for evaluation of hypoglycemia and was diagnosed as having hyperinsulinemia secondary to pancreatic hypertrophy. Factitious hypoglycemia was also ruled out. Tumor localization studies were all negative. A supervised fast could not be conducted due to the inability of the patient to tolerate the test. Her first viable pregnancy was 2 years back, during which she required a prolonged hospital (including the intensive care unit) admission with multiple in-hospital complications and requiring enteral feeding. During her current pregnancy, she experienced recurrent episodes of severe disabling hypoglycemia resulting in seizures. She was commenced on diazoxide, however, despite that, she continued to have hypoglycemic episodes for which she had to self-inject Glucagon several times. She also had unexplained weight loss with ketonemia undeterred by a high-caloric diet. She refused to be on naso-jejunal feeding or enteral feeding. She self funded a flash glucose monitor which recorded her blood glucose levels between 2.0 to 3.4 mmol/L during the episodes of hypoglycemia. Dietitians were continually involved in her care to provide nutritional support and to optimize blood glucose control through dietary manipulation. Conclusion This was a very interesting and complicated case of a genetic disorder that presented multiple challenges during pregnancy. Management focused on psychological concerns, the severe catabolic state leading to rapid weight loss, recurrent hypoglycemic episodes, ketonemia, nutritional support, and fetal well-being monitoring. A multi-disciplinary team approach to management involved the obstetrics, endocrinology, dietetics, and gastroenterology teams. This resulted in a successful outcome for her pregnancy. Very limited data is available on health issues associated with BWS in adulthood and there is no data available on the obstetric management of women with BWS. Additionally, the unexplained weight loss and ketonemia associated with hypoglycemia make this case unique. Further studies are warranted and national guidelines are required to ensure that women with BWS achieve optimum pregnancy outcomes. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Correlates of Glycemic Control Among Patients With Type 2 Diabetes in Eastern Ethiopia: A Hospital-Based Cross-Sectional Study

IntroductionEven though optimal blood glucose control reduces the risk of diabetes-related complications, many patients with type 2 diabetes (T2D) fail to achieve it for a variety of reasons. In the study area, there was a paucity of evidence regarding correlates of glycemic control. Therefore, this study aimed to find out the correlates of glycemic control among patients with T2D in Eastern Ethiopia.MethodsA cross-sectional study was conducted among 879 adult patients with T2D on follow-up at two public hospitals in Harar. Data were collected through interviews, physical measurements, and record reviews. The level of glycemic control was determined from three consecutive fasting plasma glucose (FPG) measurements. A mean value of FPG measurements falling in the normal range (80–130 mg/dl) was considered as optimal glycemic control; otherwise, a mean FPG level that is below or above the normal range (<80 mg/dl or >130 mg/dl) was defined as suboptimal glycemic control. Descriptive statistics were used to summarize the data, while a linear regression model was used to find out the correlates of glycemic control. A beta coefficient and a 95% CI reported associations. The statistical significance was declared at a p-value ≤0.05.ResultsThe mean age of the patients with T2D was 52.7 ( ± 13.3) years. The mean FPG level was 172 ± 56 mg/dl. Suboptimal glycemic control was found in 76% (95% CI: 73.41, 79.04) of patients with T2D. In a multivariable linear regression, khat chewing (β = 6.12; 95% CI: 1.55, 8.69), triglycerides (β = 0.56; 95% CI: 0.41.48, 0.65), comorbidity (β = 5.29; 95% CI: 1.39, 9.13), and poor level of self-care practices (β = 5.43; 95% CI: 1.41, 6.46) showed a significant correlation with glycemic control.ConclusionsThis study found that about three-fourths of patients with T2D had suboptimal glycemic control. Khat chewing, comorbidity, and poor level of self-care practices were independently correlated with glycemic control. Thus, suppressing glycemic levels through appropriate treatment and strict diabetes self-care practices including avoidance of Khat chewing is a useful approach to attaining glycemic target that subsequently reduces cardiovascular risks.

Fruitarian Diet and Blood Glucose Control in Type 1 Diabetes: A Case Report

Diet is a key determinant of blood glucose control in individuals with type 1 diabetes. Although dietary education is part of their clinical follow-up, many patients show a propensity to self-treatment, adopting dietary changes, often extreme, that do not consider the overall impact on health. Here, we describe the case of a patient with type 1 diabetes who switched to a fruitarian diet because of ideological beliefs. A 25-year-old man with type 1 diabetes on an insulin pump and continuous glucose monitoring on optimal blood glucose control (HbA1c 6.5%, 48 mmol/mol; glucose time-in-range 70–180 mg/dl, TIR, 90%; coefficient of variation, CV, 36%) switched to a fruitarian diet because of ideological beliefs. After 3 months on this diet, blood glucose control was still optimal (TIR 88%, CV 33%), while plasma triglycerides and liver enzymes were above normal values. After 3 more months, blood glucose control had worsened (TIR 72%, CV 37%), plasma triglyceride and liver enzymes were within normal values, and hyperkalemia was detected. In this case report, a strict fruitarian diet was associated with early negative changes in some biochemical parameters, also in presence of optimal blood glucose control. Dietary counseling remains essential in the follow-up of patients with type 1 diabetes to ensure personalized medical nutrition therapy and monitor dietary changes that may affect health but with no major impact on blood glucose control.

Degree of Control of Type II DM in Kirkuk City Using HbA1c

Background: Diabetes mellitus is a major cause of morbidity and mortality. In the Arab region, the overall prevalence of DM in the Kingdom of Saudi Arabia is (23.7%) among people with age between 30 and 70 years. The prevalence of diabetes in the United Arab Emirates, Bahrain, and Kuwait were (20.1%), (14.9%) and (12.8%), respectively. Several large clinical trials have demonstrated that tight blood glucose control correlates with a reduction in the microvascular complications of diabetes. The American Diabetes Association (ADA) has designated HbA1c level of ≤ (7%) as a goal of optimal blood glucose control, and the American Association of Clinical Endocrinologist has further recommended HbA1c level of ≤ (6.5%). Despite the evidence from large randomized controlled trials establishing the benefit of intensive diabetes management in reducing microvascular and macrovascular complications, high proportion of patients remain poorly controlled. Poor and inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and major risk factor for the development of diabetes complications. Glycemic control remains the major therapeutic objective for prevention of target organ damage and other complications arising from diabetes. Aim of the study: To estimate the proportion of the patients with poor glycemic control and determine factors associated with poor glycemic control among patients with type 2 diabetes in Kirkuk city. Materials and Methods:A cross-sectional study conducted on 500 patients with type 2 DM, were randomly selected who were attended outpatient clinic in Azadi teaching hospital or private clinic over a period of 12month in 2014. A pre-structured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviors, medication adherence, and attitude towards diabetes. Weight, and height were measured. Available last readings of hemoglobin A1c(HbA1c), were abstracted from patients' records. Poor glycemic control was defined as HbA1c ˃ (7%). Results:Of the total 500 patients, (74.2%) had HbA1c ˃ (7%). In the multivariate analysis, increased duration of diabetes,increased Body Mass Index(BMI),low education level,hypertension,type of treatment, non-adherence to diabetes self- care management behavior,poor medication adherence, were significantly associated with increased odds of poor glycemic control.(pvalue<0.005). Conclusions and recommendations: Results indicate that duration of diabetes, age, obesity and morbidity are risk factors for poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Regular checking of RBS, adherence to treatment, 30 minute exercise and followinghealthy diet are important attitude of patients towards DM for good glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence totreatment regimen, regular exercise and dietary regimen would be of great benefit in glycemic control.

A cross-sectional study on the telemedicine usage and glycemic status of diabetic patients during the COVID-19 pandemic

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic disrupts selfmanagement in diabetic patients in Indonesia. This study aimed to determine the telemedicine usage and factors contributing to glycemic control in type 2 diabetes mellitus (T2DM) patients during the pandemic.&#x0D; METHODS A cross-sectional study was conducted in T2DM patients aged 25–54 years. The questionnaire included general characteristics, diabetes conditions, consultation factors, and self-care management. Glycemic status was evaluated using glycated hemoglobin (HbA1c) levels, which was categorized into poor (HbA1c≥7%) and good glycemic control (HbA1c&lt;7%). Data were analyzed using chi-square and binary logistic regression.&#x0D; RESULTS Of 264 patients, only 19.2% used telemedicine and 60.2% had poor glycemic control during the pandemic. Overweight or obesity (odds ratio [OR] = 5.740 [95% confidence interval [CI] = 2.554–12.899]; p&lt;0.001), insulin injection (OR = 3.083 [95% CI = 1.238–7.677]; p = 0.016), and frequent fried food consumption (OR = 5.204 [95% CI = 1.631–16.606]; p = 0.005) were the factors contributing to poor glycemic control. The risk is lower if exercised regularly (OR = 0.036 [95% CI = 0.007–0.195]; p&lt;0.001) and consulted with a doctor using telemedicine (OR = 0.193 [95% CI = 0.044–0.846]; p = 0.029) or in-person visits (OR = 0.065 [95% CI = 0.016–0.260]; p&lt;0.001).&#x0D; CONCLUSIONS Glycemic control was not optimal during the COVID-19 pandemic. Therefore, keeping a healthy lifestyle and staying connected with a doctor are important to ensure optimal blood glucose control and reduce the risk of diabetesrelated complications.

Blood glucose control: Where are we?

Optimal blood glucose control warrants both early intensive therapy and individualization strategies in patients with diabetes mellitus.

Optimal impulsive blood glucose control through multiple injections

Despite numerous advances in glycemic control based on the artificial pancreas, Multiple Daily Injections (MDI) are still the most common method in type 1 diabetes mellitus patients. In the present study, an optimal impulsive control approach is introduced to attain a safe range of blood glucose considering the daily life factors, including food intake and exercise. Depending on the food intake and exercise, the proposed impulsive control signal can determine the optimal exogenous insulin dosages per day. MDI program for type 1 diabetic patients due to several overeating conditions, with and without exercise, is a blood glucose control program. This program can conveniently help the patients to manage unwanted conditions such as missed insulin injections or meals. The recommended approach is investigated on the comprehensive glucose-insulin model of diabetic subjects, and it effectively determines the time and magnitude of the insulin injection dosages. Based on the simulation results, three times injection mode in terms of hypoglycemia and severe hyperglycemia risks is efficient and dosages times and magnitudes are well determined in different food intake scenarios by the proposed approach. This approach can significantly help physicians to regulate blood glucose in a sophisticated optimal, reliable route.

Associations between continuous glucose monitoring-derived metrics and diabetic retinopathy and albuminuria in patients with type 2 diabetes

IntroductionPreventing the development and progression of diabetic microvascular complications through optimal blood glucose control remains an important challenge. Whether metrics based on continuous glucose monitoring are useful for the management...

TB and COVID-19: paying attention to diabetes mellitus.

In 2019, global diabetes prevalence was 463 million. Diabetes increases the risk of TB and adverse treatment outcomes including death and relapse. Diabetes also increases the risk of severe disease, multi-organ failure, coagulopathy and death in COVID-19. TB and COVID-19 share many features, suggesting opportunities to integrate prevention, diagnosis and care. Three areas for further work are highlighted: better infection control in diabetes clinics, easier and quicker diagnosis using similar technology platforms and optimal blood glucose control. The funding and resources for COVID-19 should be harnessed to improve TB and diabetes care and achieve their respective sustainable development goal targets.

An Automatic Insulin Infusion System Based on Kalman Filtering Model Predictive Control Technique

Abstract During the past few decades, optimal control of blood glucose (BG) concentration with adequate feedback loop has been of ample importance for Type-I diabetes mellitus (TIDM) patients as far as an artificial pancreas realization is concerned. Now-a-days, in addition to the BG control, the design of the micro-insulin dispenser (MID) with a robust control algorithm to regulate the other chronic clinical disorders based on prolonged medications is also quite indispensable. A novel Kalman filtering model predictive controller (KFMPC) has been proposed in this work to solve the aforementioned problem. For designing of the KFMPC, a ninth-order state-space model of the TIDM patient with MID is considered. In this control strategy, the conventional model predictive controller is re-formulated with a state estimator based on the Kalman filtering methodology to improve the control execution. The justification of enhanced control performance of KFMPC is demonstrated by comparative result analysis with other published control techniques. The simulations are carried out through matlab/simulink environment, and the results indicate comparatively better control ability of the suggested algorithm to control the BG level within the normoglycemic range (70–120 mg/dl) as far as accuracy, stability, quick damping, and robustness.

Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors: Benefits in Diabetics With Cardiovascular Disease.

Optimal blood glucose control helps reduce the development of the complications of type II diabetes mellitus (T2DM). T2DM patients usually are at increased risk of cardiovascular (CV) events and mortality. Therapies and strategies to treat diabetes and its related CV outcomes still need more investigation to find the best management options for this population. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have several benefits over multiple organ systems of the human body. However, the comparative effectiveness of this drug class is still not well-established. Our review aims to assess SGLT-2 inhibitors' effects on the CV complications that occur because of uncontrolled diabetes.A comprehensive literature search was conducted on PubMed and PubMed Central to find the relevant studies that were done from 2016 through 2020 to gather data for this review article. Those studies include reviews, randomized clinical trials, systematic reviews, and meta-analyses.Studies used in this article found an associated decrease in CV complications and mortality in patients with T2DM who received treatment with SGLT-2 inhibitors compared to the placebo group. These drugs have shown significant efficacy and safety outcomes in diabetic patients with heart disease, as they are glycosuric and diuretics, both of which are characteristics that could provide benefits to this population.SGLT-2 inhibitors appear to reduce the risk of cardiovascular events and mortality, suggesting that the benefits of these drugs seen in people with diabetes may apply to a broad population in the real world. We recommend further studies should confirm the immense clinical benefits with SGLT-2 inhibitors in patients with T2DM.

Mental health among patients in a COVID-19-dedicated facility.

In 2019, global diabetes prevalence was 463 million. Diabetes increases the risk of TB and adverse treatment outcomes including death and relapse. Diabetes also increases the risk of severe disease, multi-organ failure, coagulopathy and death in COVID-19. TB and COVID-19 share many features, suggesting opportunities to integrate prevention, diagnosis and care. Three areas for further work are highlighted: better infection control in diabetes clinics, easier and quicker diagnosis using similar technology platforms and optimal blood glucose control. The funding and resources for COVID-19 should be harnessed to improve TB and diabetes care and achieve their respective sustainable development goal targets.

Automatically accounting for physical activity in insulin dosing for type 1 diabetes

Background and ObjectiveType 1 diabetes is a disease characterized by lifelong insulin administration to compensate for the autoimmune destruction of insulin-producing pancreatic beta-cells. Optimal insulin dosing presents a challenge for individuals with type 1 diabetes, as the amount of insulin needed for optimal blood glucose control depends on each subject's varying needs. In this context, physical activity represents one of the main factors altering insulin requirements and complicating treatment decisions. This work aims to develop and test in simulation a data-driven method to automatically incorporate physical activity into daily treatment decisions to optimize mealtime glycemic control in individuals with type 1 diabetes. MethodsWe leveraged glucose, insulin, meal and physical activity data collected from twenty-three individuals to develop a method that (i) tracks and quantifies the accumulated glycemic impact from daily physical activity in real-time, (ii) extracts an individualized routine physical activity profile, and (iii) adjusts insulin doses according to the prolonged changes in insulin needs due to deviations in daily physical activity in a personalized manner. We used the data replay simulation framework developed at the University of Virginia to “re-simulate” the clinical data and estimate the performances of the new decision support system for physical activity informed insulin dosing against standard insulin dosing. The paired t-test is used to compare the performances of dosing methods with p < 0.05 as the significance threshold. ResultsSimulation results show that, compared with standard dosing, the proposed physical-activity informed insulin dosing could result in significantly less time spent in hypoglycemia (15.3± 8% vs. 11.1± 4%, p = 0.007) and higher time spent in the target glycemic range (66.1± 11.7% vs. 69.6± 12.2%, p < 0.01) and no significant difference in the time spent above the target range(26.6± 1.4 vs. 27.4± 0.1, p = 0.5). ConclusionsIntegrating daily physical activity, as measured by the step count, into insulin dose calculations has the potential to improve blood glucose control in daily life with type 1 diabetes.