Optimal Glycemic Control Research Articles

Background: We recently found poor glycemic control (Hgb A1c >8%) to be strongly associated with increased risk of cardiovascular (CV) and limb events in diabetic patients with peripheral artery disease (PAD). Hypothesis: The association between glycemic control and risk of CV and limb events is modified by age. Methods: Using data from Peripheral Artery Disease: Long-term Survival Study (PEARLS), we identified diabetic PAD patients with at least one Hgb A1c in the two years before the index (date of PAD diagnosis), and at least one Hgb A1c within 2 years after the index but before first CV (myocardial infarction, stroke) or limb (chronic limb threatening ischemia, major amputation) event. Longitudinal glycemic control was assessed using HgbA1c and categorized as tight (≤7%; reference), moderate (>7% to 8%), and poor (>8%). Multivariable Cox proportional hazards models with longitudinal HgbA1c as a time-varying exposure and death as a competing risk examined the association between glycemic control and risk of clinical events. Analyses were stratified by median age (<70 years vs. >70 years). Results: Among 45,934 patients, 97.8% were men, and 19.8% were Black. Compared to the <70-year group, those >70 years had lower baseline Hgb A1c (7.3% vs. 7.8%). Older patients were also less likely to be Black, be active smokers but had a higher prevalence of most co-morbidities (Table 1). In risk-adjusted analyses using longitudinal HgbA1c as a time-varying exposure, poor glycemic control was associated with increased risk of CV events (Figure 1), with Hgb A1c >8% associated with a 44% increased hazard compared to HgbA1c <7% category (sub-distribution hazard ratio [sHR]: 1.44; 95% CI: 1.37-1.52). The association between glycemic control and risk of limb events was even stronger, with 74% higher risk in those with HgbA1c>8%, compared to HgbA1c <7% (sHR: 1.74; 95% CI: 1.65-1.83; Figure 2). In both age groups, there was no heterogeneity in the association between glycemic control with CV (P-value for interaction term: 0.40) and limb events (P-value for interaction term: 0.09). Conclusions: We found a graded, positive association between poor glycemic control and risk of CV and limb events. This association was consistent in both younger and older patients. Our findings indicate that optimal glycemic control may be beneficial in reducing the risk of clinical events, regardless of age.

Background Although determinants of glycaemic control in type 2 diabetes mellitus (T2DM) have been extensively investigated, the joint influence of sleep quality and physical activity (PA) remains insufficiently studied. We aimed to examine the independent and combined associations of sleep quality and PA with glycaemic control in patients with T2DM. Methods We conducted a cross-sectional study of 329 patients with T2DM. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). PA was self-reported through questionnaires and expressed as metabolic equivalents (METs). Associations between sleep quality, PA, and glycaemic control were assessed using multivariable logistic regression. Results After adjusting for confounding factors, we observed that declining habitual sleep efficiency was associated with an increased risk of suboptimal glycaemic control (OR 1.64, 95% CI 1.14–2.43). Participants with poorer sleep quality had a higher risk of suboptimal glycaemic control compared with those with better sleep quality (OR 2.09, 95% CI 1.09–4.09). High PA was associated with a significantly lower risk of poor glycaemic control compared with low PA (OR 0.20, 95% CI 0.05–0.68). In combined analyses, the greatest reduction in the risk of poor glycaemic control was observed in participants with good sleep quality and moderate PA, compared to those with poor sleep quality and low PA (OR 0.38, 95% CI 0.14–0.98). Conclusion In patients with T2DM, achieving optimal glycaemic control requires not only maintaining PA but also improving sleep quality.

Abstract Disclosure: C. Yin: None. C.A. Board: None. A. Gopalan: None. Introduction: Adults diagnosed with type 2 diabetes (T2D) at a younger age are at increased risk of developing complications and premature mortality. Younger adults are less likely to achieve evidence-based glycemic targets, with age-based differences apparent within a year of diagnosis. A family history of T2D is a well-established risk factor for younger onset T2D. Understanding if having firsthand experiences with T2D relates to early glycemic outcomes may inform more tailored initial T2D self-management support for this high-risk patient population. We examined the association between self-reported personal T2D experiences and achievement of early glycemic targets in a population of newly diagnosed younger adults. Methods: We conducted a prospective survey of younger adult members (21-44 years) of a large, integrated healthcare system who were diagnosed with T2D within the prior 6 months. Individuals with type 1 diabetes or gestational diabetes were excluded. In the survey, we asked respondents about their family history of T2D (any family T2D history, parent with T2D), family and friends' success or struggle with T2D self-management, and family and friends' experiences of T2D complications or death. These individuals' HbA1c levels at one year following diagnosis were then abstracted from the EHR, with optimal glycemic control defined as an A1c≤7%. Chi-square, t-tests, and one-way ANOVA were used to examine associations between personal experiences and 1-year HbA1c. Results: Of the 610 survey respondents, 46.7% were male, the average age was 38 years, 32.1% were Latino, and 25.1% were Asian. Of those with an available 1-year A1c, 72.5% had a value ≤7%. Most (83.6%) reported a family history of T2D, with the majority having a parent with T2D (63.7%); this did not differ by A1c at 1 year (any family history: 84.2% A1c ≤7% vs. 81.9% A1c>7%, p=0.49; parent with T2D: 63.2% A1c≤7% vs. 65.3% A1c>7%, p=0.65). One-year A1c was also not significantly associated with having a family/friend who successfully made lifestyle changes (61.8% A1c ≤7%. vs. 57.6% A1c>7%, p=0.38), struggled with managing T2D (41.3% A1c≤7% vs. 36.1% A1c>7%, p=0.28), or experienced a serious complication or death from T2D (38.7% A1c≤7% vs. 40.3% A1c>7%, p=0.74). Conclusion: Most younger adults diagnosed with T2D receive this diagnosis in the context of personal experience, both positive and negative, with this disease. The presence and nature of these personal experiences, including knowing someone who experienced a complication or died from T2D, were not associated with achieving glycemic targets at one-year. These findings suggest that the relationship between past personal T2D experiences and personal engagement in initial T2D self-management may be complex. Future work should examine how these prior experiences relate to known mediators of glycemic control, such as self-efficacy, distress, and fatalism. Presentation: Monday, July 14, 2025

Background/Objectives: Optimal postprandial glycemic control is crucial to maintain time in range (TIR:3.9–10.0 mmol/L, 70–180 mg/dL) and time in tight range (TITR:3.9–7.8 mmol/L, 70–140 mg/dL), both important to reduce microvascular complications in type 1 diabetes mellitus (T1DM). However, insulin dosing based on carbohydrate counting fails to compensate for delayed hyperglycemia from protein and fat. This study evaluated two advanced insulin dosing algorithms designed to improve postprandial control in adolescents with T1DM. Methods: In this randomized, prospective, double-blind, crossover trial, 58 adolescents with T1DM (median age 15.5 years) were enrolled, all using continuous subcutaneous insulin infusion and a continuous glucose monitoring system in non-automated mode. For two consecutive days, participants consumed standardized mixed meals for breakfast (50 g of carbohydrates, 200 kcal from protein and fat) and received an extended bolus delivered for four hours, based on the Pankowska Equation (PE, i.e., Fat-Protein Units × Insulin-to-Carbohydrate Ratio (ICR)) and the Sieradzki Equation (SE, i.e., 30% × Carbohydrate Units × ICR). Postprandial glucose was monitored for five hours using a glucometer and Continuous Glucose Monitoring (CGM). The primary outcome was the capillary blood glucose level at predefined time points. The secondary outcomes were the frequency of hypoglycemia and glycemic variability parameters. Results: Both methods kept postprandial glucose within the recommended TIR. The SE method provided longer TITR (82.51% vs. 70.49%, p = 0.6281) and fewer hypoglycemic episodes at 180 and 300 min. Glucose levels at 60 min, were higher after PE (136 ± 35.2 mg/dL vs. 124 ± 32.2 mg/dL, p = 0.016). Conclusions: Both algorithms provided effective postprandial control after a mixed meal, but SE achieved a longer TITR and fewer late hypoglycemic events.

Diabetes mellitus is a serious global health issue, impacting hundreds of millions of people. Current management of diabetes focuses on achieving optimal glycemic control through consistent glucose monitoring. While insulin is crucial for regulating blood glucose levels, its role extends beyond insulin therapy and is often underutilized. Estimating insulin resistance is vital for early diagnosis of type 2 diabetes and improving insulin dosing accuracy. Fasting insulin measurements facilitate the assessment of insulin resistance using the homeostasis model assessment for insulin resistance (HOMA-IR), which correlates well with the gold standard research methods. Despite its potential, the current clinical practices face limitations such as prolonged detection times, centralization, and high costs, which hinder routine monitoring. There is an urgent need for a reliable, portable, and cost-effective real-time insulin detection device. Aptasensors, widely developed across various industries, offer a promising solution. These sensors promise fast, affordable, and simple measurement while maintaining high sensitivity. This review explores recent developments in insulin-binding aptamers and aptasensors, emphasizing optical and electrochemical biosensors. Their analytical performance, including specificity, sensitivity, and detection limits is discussed. Addressing the limitations of current biosensors, such as sensitivity, selectivity, and response time, is essential for advancing affordable and reliable insulin monitoring.

Introduction: COVID-19 is caused by SARS-CoV-2. Individuals with type 2 diabetes mellitus are a main risk group for its severe and often fatal course. Aim: In this review we examine the pathogenetic relationship, clinical outcome, and current therapeutic strategies in patients with type 2 diabetes mellitus, suffering from COVID-19. Material and Methods: Data from international studies were integrated, with particular focus on hospitalized patients from the targeted group. Pathophysiological mechanisms, risk factors, and outcomes were systematically analyzed. Results and Discussion: Diabetes mellitus is associated with impaired innate and adaptive immunity, chronic systemic inflammation, endothelial dysfunction, and a prothrombotic state. Hyperglycemia and insulin resistance increase ACE2 and furin expression, facilitating viral entry and its replication. In diabetic patients with COVID-19, higher rates of hospitalization, intensive care admission, and the need for mechanical ventilation are frequently reported. Optimal glycemic control is crucial, as both hyper- and hypoglycemia worsen the outcomes. Insulin remains the preferred therapeutic agent in hospitalized patients, with emerging evidence supporting the use of SGLT-2 and DPP-4 inhibitors. Conclusion: Type 2 diabetes mellitus is a significant risk factor for severe COVID-19. The underlying pathogenesis involves a complex interplay of immune dysfunction, chronic inflammation, endothelial damage, and metabolic regulation, indicating bidirectional relationship. Achieving optimal glycemic control, managing comorbidities, and ensuring early medical intervention are essential strategies for improving prognosis in this high-risk population.

Background: Assessing medication adherence is crucial for patients with type 1 diabetes (T1DM), as it is a primary obstacle to achieving optimal glycemic control in this population. However, none of the currently available tools to assess medication adherence are specific to Iraqi patients with T1DM. Objective: To assess the reliability and validity of the Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS) among Iraqi patients with T1DM. Methods: This cross-sectional study was conducted from January 29 to May 29, 2025, at the Faiha Specialized Diabetes, Endocrine, and Metabolism Center in Basrah, Iraq. It involved 100 Iraqi T1D patients aged≥12 years diagnosed for at least 12 months and on stable treatment for at least 3 months. Participants completed a paper-based IADMAS questionnaire at baseline. Reliability was assessed using Cronbach’s alpha. For test-retest reliability, 24 participants completed the questionnaire again after two weeks, and their scores were correlated using Spearman’s rho. Concurrent validity was examined by comparing IADMAS scores with HbA1c levels. Results: The internal consistency of IADMAS, assessed using Cronbach's alpha (0.217). It can be slightly elevated to 0.266 if item 4 is removed. Regarding the test-retest results, the correlation for the total IADMAS scores was 0.458(p=0.024). By inspecting individual items within IADMAS, two items showed significant differences between test and retest values. There was a non-significant association between IADMAS score and HbA1c (Spearman's ρ = −0.087, p=0.391). Conclusions: IADMAS has poor validity and reliability and hence it is not suitable to assess medication adherence among T1DM patients.

Objectives: Type 2 diabetes mellitus (T2DM) needs continuing adherence and effective self-management strategies to achieve optimal glycemic control. This investigation sought to explore the link between pillbox usability and patient adherence, patient adherence, and random blood glucose (RBG) levels, in addition to pillbox usability and RBG levels in T2DM. Methods: This observational study involved 33 patients with T2DM receiving care from the Lubuk Kilangan Primary Health Center, selected through purposive sampling. Pillbox usability was assessed using the System Usability Scale questionnaire, medication adherence was measured over a monthly period using the pill count method, and RBG data were obtained from patients’ clinical records. Data were analyzed using Spearman’s rank correlation test to consider relationships between variables. Results: The findings indicated no significant correlation between pillbox usability and either medication adherence or RBG levels (p>0.05). However, a significant negative link existed between medication adherence and RBG levels, with moderate strength (r=−0.456; P=0.008). Conclusion: These findings point to improved medication adherence contributing to better glycemic control, as indicated by lower RBG levels. Nevertheless, pillbox usability was not found to have a significant impact on either adherence or blood glucose control.

Background: The increasing prevalence of diabetes mellitus has intensified the need for effective perioperative glycemic control to reduce surgical complications. Hyperglycemia during surgery is linked to poor outcomes, including infections, delayed healing, and increased mortality. Aim: This article aims to present evidence-based, interprofessional strategies for managing perioperative glycemic control in diabetic patients, emphasizing the roles of pharmacists, anesthesiologists, and nurses. Methods: A comprehensive review of current guidelines and clinical trials was conducted, focusing on perioperative glucose targets, insulin regimens, and medication adjustments. The article synthesizes recommendations from major professional societies and integrates findings from randomized controlled trials such as NICE-SUGAR and SITA-HOSPITAL. Results: Optimal glycemic control (140–180 mg/dL) across perioperative phases significantly improves outcomes. Preoperative planning includes medication adjustments and HbA1c assessment. Intraoperative management favors intravenous insulin for complex surgeries, while postoperative care requires individualized insulin regimens based on nutritional intake and clinical status. Pharmacists ensure safe medication transitions, nurses provide continuous monitoring and education, and anesthesiologists manage intraoperative glucose fluctuations. Conclusion: Effective perioperative diabetes management demands coordinated, multidisciplinary care. Structured protocols, individualized insulin therapy, and continuous glucose monitoring are essential to minimize complications and enhance recovery. Interprofessional collaboration is critical for safe transitions across surgical phases and discharge planning.

Continuous glucose monitoring (CGM) has become a key component in the management of pediatric type 1 diabetes mellitus (T1DM) since it offers real-time glucose data that facilitate tighter glycemic control and reduce acute complications. Accumulating evidence and international guidelines highlight the clinical efficacy, safety, and feasibility of CGM use in children, particularly those with high adherence. Regular CGM use is associated with significant reductions in glycated hemoglobin, fewer hypo- and hyperglycemia episodes, and improved quality of life for both patients and their caregivers. Recent advances in CGM technology-including improved accuracy, extended sensor wear, factory calibration, and customizable alerts-have enhanced their usability in pediatric populations. In addition to established CGM metrics such as time in range, time below range, and glycemic variability, a novel parameter-time in tight range (also referred as time in normoglycemia), defined as the percentage of time with blood glucose readings within 70-140 mg/dL-has emerged as a potentially more sensitive marker of optimal glycemic control in children. This review provides a comprehensive overview of CGM technologies, including device types, performance metrics, and clinical evidence supporting their use for pediatric T1DM. It also examines recent advancements in Korea such as expanded insurance reimbursement and clinical integration. As CGM becomes more accessible and technologically advanced, it is expected to play an increasingly central role in optimizing long-term outcomes for children and adolescents with T1DM.

To examine whether glycemic level modifies the association between gestational weight gain (GWG) and pregnant outcomes in type 2 diabetes-complicated pregnancies. This multicenter retrospective study stratified 1,642 pregnant women with diabetes by third-trimester glycemic control. Associations between excessive GWG (eGWG) and pregnant outcomes were analyzed by group. Although birth weight and odds of macrosomia and cesarean delivery were higher for all women with eGWG relative to those with adequate GWG, the effect estimates for birth weight and macrosomia were significantly higher with suboptimal glycemic control compared with optimal control (birth weight increase: 361.04 vs. 126.07 g, respectively, P = 0.007; adjusted odds ratio for macrosomia: 4.26 vs. 2.73, P = 0.002; cesarean delivery: 1.86 vs. 1.52, P = 0.738). Overly stringent weight control should be treated with caution if optimal glycemic control is not achieved.

Time critical charcot foot reconstructions can be safely performed in the absence of optimal preoperative glycaemic control when delivered by MDT.

Background:Many individuals living with type 2 diabetes mellitus (T2DM) struggle to maintain optimal glycaemic control. Reports from Nigeria show particularly high rates of poor glycaemic control, increasing the risk of microvascular and macrovascular complications. Little research has explored the lived experiences of individuals living with T2DM with poor glycaemic control in Nigeria, particularly in secondary healthcare settings, to guide improvements in care.Objective:This study explored the experiences of individuals living with T2DM with poor glycaemic control.Method:A qualitative research design was used. Semi-structured, individual interviews were conducted with 14 participants, aged 35 to 74 years, recruited from 3 secondary healthcare institutions in Lagos, Nigeria.Results:Four key themes were generated: (1) Beyond the T2DM diagnosis, which captures the perceptions of T2DM, the financial burden of the condition, and the onset of physical health issues associated with T2DM; (2) Psychological impact of T2DM, which highlights mental health difficulties and experiences of stigma; (3) Managing and living with T2DM, which describes the use of traditional medicine, the influence of religious beliefs and the importance of community and social networks and (4) Diabetes care at secondary healthcare institutions, which highlights patient-provider interactions and the gaps in information and education.Conclusion:The findings provide valuable insight into the lived experiences of individuals with T2DM with poor glycaemic control and underscore the importance of addressing knowledge gaps and providing psychological support as integral components of comprehensive diabetes care.

Type 2 diabetes mellitus (T2DM) is a chronic disease with a high risk of complications, requiring optimal glycemic control. This case report aims to describe the use of continuous glucose monitoring (CGM) in the evaluation of a patient with T2DM and obesity whose glycemic levels remained uncontrolled despite high-dose insulin therapy. A 58-year-old woman with an 18-year history of T2DM presented to the Endocrinology Clinic of Cipto Mangunkusumo Hospital with uncontrolled blood glucose accompanied by classic diabetic symptoms. CGM revealed that the majority of glucose levels were within the time above range (TAR) at 83% without hypoglycemia, while the time in range (TIR) was only 17%. Contributing factors included a high-carbohydrate diet, limited physical activity, and technical difficulties with insulin injection. Interventions consisted of dietary re-education, gradual physical activity, optimization of injection technique, and insulin dose adjustment. CGM provided a comprehensive glycemic profile and helped identify non-pharmacological factors hindering glycemic control. This case highlights the role of CGM as an essential tool for individualized therapy in patients with T2DM requiring high-dose insulin.

<p><strong><em>Background: </em></strong><em>Self-management plays a pivotal role in the management of Type 2 Diabetes Mellitus (T2DM). Active patient participation is crucial for achieving optimal glycemic control, preventing complications, and enhancing overall quality of life in the context of long-term, sustainable disease management.</em></p><p><strong><em>Objectives: </em></strong><em>This study aims to analyze the factors influencing self-management in patients with T2DM, to provide a foundation for developing more effective interventions that support patients in independently managing their condition.</em></p><p><strong><em>Methods: </em></strong><em>This study employed a literature review method by analyzing articles published within the last five years from the PubMed, ScienceDirect, and ProQuest databases. The search keywords used were “Self-management, Type 2 Diabetes Mellitus, and Factors influencing.” Out of 1,168 identified articles, 22 articles were selected based on relevant inclusion criteria, with a primary focus on self-management and its influencing factors in T2DM patients.</em></p><p><strong><em>Results: </em></strong><em>Self-management in patients with T2DM is influenced by both internal and external factors as well as individual skills. Key contributing factors include family support, cultural values, self-efficacy, emotional regulation, and time management. These elements interact dynamically, demonstrating that patients’ ability to manage diabetes is not determined by a single factor but rather by an integration of psychological readiness, supportive environments, and contextual influences. The findings highlight the importance of designing interventions that are holistic, culturally sensitive, and adaptable to patients’ daily realities. A holistic intervention approach, grounded in the bio-psycho-social and cultural model, is needed to enhance the effectiveness of self-management.</em></p><strong><em>Conclusions: </em></strong><em>Self-management is a crucial component in the management of T2DM. Ineffective implementation may lead to poor disease control and an increased risk of complications. Therefore, understanding the factors influencing self-management is essential for supporting sustainable and independent diabetes care.</em>

RationaleType 1 diabetes mellitus (T1DM) is characterized by autoimmune destruction of pancreatic β-cells, leading to insulin deficiency and hyperglycemia. Although insulin therapy remains the cornerstone of T1DM management, achieving optimal glycemic control remains challenging. Dipeptidyl peptidase-4 (DPP-4) inhibitors, approved for type 2 diabetes, enhance endogenous incretin action and may enhance β-cell function. Some clinical trials have explored their adjunctive use in T1DM. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of DPP-4 inhibitors as an adjunct to insulin in patients with T1DM.MethodsWe systematically searched PubMed, Cochrane Library, Medline (OVID), Scopus, and ClinicalTrials.gov up to January 2025 for eligible studies. Randomized controlled trials (RCTs) investigating DPP-4 inhibitors versus placebo, both on top of insulin therapy for at least 12 weeks in T1DM patients, were included. The primary outcome was the change in HbA1c. Secondary outcomes included blood glucose, C-peptide, insulin dosage, BMI, weight, adverse events, and HOMA2-β scores. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Data were pooled using a random-effects model, with effect sizes expressed as mean differences (MD) and 95% confidence intervals (CI).ResultsOut of 1,117 identified studies, seven RCTs comprising 333 participants (176 in the experimental group, 157 in the control group) were included. The addition of DPP-4 inhibitors did not result in a significant or sustained reduction in HbA1c overall, except for a transient improvement between 3 and 6 months (MD −0.10%, 95% CI −0.16 to −0.05, p = 0.0003). DPP-4 inhibitors significantly reduced daily insulin requirements, particularly bolus doses, and postprandial blood glucose (by −34.40 mg/dL), especially in patients with a BMI < 25 kg/m² and diabetes duration <3 years. No significant effects were observed on weight, BMI, fasting blood glucose, fasting or postprandial C-peptide beyond three months. HOMA2-β scores were significantly higher with DPP-4 inhibitors. Safety outcomes were comparable between groups.ConclusionsDPP-4 inhibitors appear safe as adjunct therapy to insulin in patients with T1DM. Although they do not offer sustained HbA1c reduction, they may reduce daily insulin requirements, improve postprandial glucose, and transiently enhance β-cell function. Further large-scale studies are needed to better define the subgroups that might benefit from this strategy.RegistrationThis study was registered in PROSPERO (CRD42024610965)

Type 1 diabetes mellitus (T1DM) is characterized by autoimmune destruction of pancreatic β-cells, leading to insulin deficiency and hyperglycemia. Although insulin therapy remains the cornerstone of T1DM management, achieving optimal glycemic control remains challenging. Dipeptidyl peptidase-4 (DPP-4) inhibitors, approved for type 2 diabetes, enhance endogenous incretin action and may enhance β-cell function. Some clinical trials have explored their adjunctive use in T1DM. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of DPP-4 inhibitors as an adjunct to insulin in patients with T1DM. We systematically searched PubMed, Cochrane Library, Medline (OVID), Scopus, and ClinicalTrials.gov up to January 2025 for eligible studies. Randomized controlled trials (RCTs) investigating DPP-4 inhibitors versus placebo, both on top of insulin therapy for at least 12 weeks in T1DM patients, were included. The primary outcome was the change in HbA1c. Secondary outcomes included blood glucose, C-peptide, insulin dosage, BMI, weight, adverse events, and HOMA2-β scores. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Data were pooled using a random-effects model, with effect sizes expressed as mean differences (MD) and 95% confidence intervals (CI). Out of 1,117 identified studies, seven RCTs comprising 333 participants (176 in the experimental group, 157 in the control group) were included. The addition of DPP-4 inhibitors did not result in a significant or sustained reduction in HbA1c overall, except for a transient improvement between 3 and 6 months (MD -0.10%, 95% CI -0.16 to -0.05, p = 0.0003). DPP-4 inhibitors significantly reduced daily insulin requirements, particularly bolus doses, and postprandial blood glucose (by -34.40 mg/dL), especially in patients with a BMI < 25 kg/m² and diabetes duration <3 years. No significant effects were observed on weight, BMI, fasting blood glucose, fasting or postprandial C-peptide beyond three months. HOMA2-β scores were significantly higher with DPP-4 inhibitors. Safety outcomes were comparable between groups. DPP-4 inhibitors appear safe as adjunct therapy to insulin in patients with T1DM. Although they do not offer sustained HbA1c reduction, they may reduce daily insulin requirements, improve postprandial glucose, and transiently enhance β-cell function. Further large-scale studies are needed to better define the subgroups that might benefit from this strategy. This study was registered in PROSPERO (CRD42024610965).

Achieving optimal glycemic control remains challenging for many individuals with type 1 diabetes using multiple daily injections. We report results from a 12-week, open-label, randomized controlled trial evaluating a decision support system (DSS) consisting of a mobile application and a titration algorithm that provides weekly basal and prandial insulin recommendations. Eighty-four adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥ 7.5%) are randomized 1:1 to receive the DSS or a non-adaptive bolus calculator (control), alongside Freestyle Libre glucose sensors. The primary endpoint is change in HbA1c from baseline; secondary endpoints include additional glycemic and insulin-related metrics. The DSS reduces mean HbA1c from 8.6% (SD 1.1) to 8.1% (0.8) (p = 0.0002), while the control reduces HbA1c from 8.6% (1.0) to 8.5% (1.0) (p = 0.22); yielding a treatment effect of –0.40% (95% CI: –0.75 to –0.051; p = 0.025). There are no reported severe hypoglycemia or diabetic ketoacidosis events. Our DSS improves HbA1c in this population without compromising safety. ClinicalTrials.gov: NCT04123054.

Diabetes mellitus is a worldwide health problem with rising morbidity and mortality. Even with improved treatment, most patients are unable to gain optimal glycemic control because of nonadherence, inadequate self-care, and insufficient disease awareness. Organized patient education programs can enhance the management of diabetes by raising awareness, promoting lifestyle changes, and improving treatment adherence.

BackgroundType II diabetes mellitus (T2DM) is characterized by glucose metabolic dysregulation, which may be addressed through integrative physiological interventions. Guided by Holistic Integrative Physiology and Medicine (HIPM) theory, this study investigates dynamic blood glucose changes in 11 T2DM patients with chronic comorbidities before and after cardiopulmonary exercise testing (CPET)-prescribed exercise to identify optimal multifactorial glycemic control strategies.MethodsEleven patients with T2DM who underwent 11 T2DM patients (2020–2022, Fuwai Hospital) underwent CPET for exercise intensity prescription. Continuous ambulatory blood glucose monitoring was conducted for each participant. Various parameters, including their fasting and postprandial peak glucose levels, exercise start and end times, post-exercise relative lows, rebound peak, low before eating fruits and vegetables at lunch, blood glucose levels, and the corresponding times at which carbohydrates were eaten, were observed and recorded. The time before exercise started was considered the zero point, and the difference in blood glucose between each point and the start of exercise, as well as the percentage difference, were calculated. Analysis of variance (ANOVA) was used to compare time points and blood glucose data for the entire group. Paired samples t-tests were used to compare adjacent time points and blood glucose data.ResultsAll patients exhibited post-breakfast peak fasting plasma glucose. Exercise initiation induced significant declines in blood glucose, continuing to nadir post-exercise. Levels subsequently rose slightly to a secondary peak before gradually declining to a second nadir prior to fruit/veg intake. Pre-lunch carbohydrate intake was associated with stable euglycemia (all P<0.001).ConclusionsHIPM-based lifestyle management (exercise, nutrition, rest) rapidly modulates hyperglycemia in T2DM patients. Exercise-induced metabolic improvements enhance respiratory-circulatory homeostasis, providing a mechanistic basis for integrated chronic disease management strategies.