Patients Receiving Insulin Treatment Research Articles

Assessing the Impact of Infographics Messaging via Mobile Chat Application on HbA1c Levels and Behavior in Diabetic Patients: A Randomized Controlled Study

Background: Lifestyle modification is the most important method for preventing diabetes and disease progression. Mobile-health technology studies show positive results in diabetic patients in developed countries, however, the results in developing countries are controversial. Objective: To assess the impact of infographic messaging on HbA1c levels and behavior in diabetic patients. Materials and Methods: A randomized controlled trial was conducted involving 165 diabetic patients from Chaiyaphum Hospital. Participants were randomized into a control group and a messaged group, with messages sent approximately three times per week to the latter. Follow-up assessments were conducted every three months for a total of nine months, measuring HbA1c, fasting blood glucose, blood pressure, and behavior using a questionnaire. The primary outcome measure was the rate of HbA1c change per visit. Regression analysis of repeated measures was performed to compare the mean difference between the groups. Results: Baseline characteristics were similar between groups, with no significant differences found. Overall, there was no significant difference in adjusted HbA1c change rate between groups (0.04, 95% CI –0.14 to 0.22, p=0.653). Subgroup analysis revealed no significant difference in patients receiving insulin treatment (–0.002, 95% CI –0.39 to 0.38, p=0.991). However, a significant decrease in the adjusted HbA1c change rate was observed in the messaged group for patients not receiving insulin treatment (–0.67, 95% CI –0.93 to –0.4, p<0.001). The messaged group also demonstrated a significant decrease in bad-behavior score (4.75±2.4, 95% CI 0.02 to 9.51, p=0.025). Conclusion: While infographic messaging via mobile phone chat application did not significantly reduce HbA1c levels in diabetic patients overall, it effectively improved diabetic behavior. Notably, for patients without insulin treatment, the intervention led to a significant decrease in adjusted HbA1c change rate, suggesting its potential effectiveness in this subgroup.

Risk of breakthrough SARS-CoV-2 infection and clinical outcomes among vaccinated patients with type 2 diabetes.

To explore the risk of breakthrough infection among patients with type 2 diabetes (T2D) and risk of severe clinical outcomes after SARS-CoV-2 infection according to vaccination status. We conducted a population-based cohort study using South Korea's linked database of nationwide COVID-19 registry and claims data between 2018 and 2021. Hazard ratios (HRs) and 95% confidence intervals (CIs) for breakthrough infections were measured in1:1 propensity-score (PS)-matched fully vaccinated patients with versus without T2D (full-vaccination cohort), and HRs for all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) use, and hospitalizations after SARS-CoV-2 infection were measured in 1:1 PS-matched T2D patients with versus without full-vaccination (T2D cohort). After 1:1 PS matching, 2 109 970 patients with and without T2D were identified (age 63.5 years; 50.9% male). Patients with T2D showed an increased risk of breakthrough infections compared to those without T2D (HR 1.10, 95% CI 1.06-1.14). The increased risk of breakthrough infections was more notable among T2D patients receiving insulin treatment. However, the risk of severe COVID-19 outcomes was lower in fully vaccinated T2D patients compared with unvaccinated T2D patients (all-cause mortality: HR 0.54, 95% CI 0.43-0.67; ICU admission/MV use: HR 0.31, 95% CI 0.23-0.41; hospitalization: HR 0.73, 95% CI 0.68-0.78). While patients with T2D remain a vulnerable population to SARS-CoV-2 infection even after full-vaccination, full-vaccination was associated with a lower risk of adverse clinical outcomes after SARS-CoV-2 infection. These findings support the guidelines recommending patients with T2D as a priority vaccination group.

Evaluating the Utilization of a Perioperative Hyperglycemic Protocol: A Quality Improvement Project

PurposeThe purpose of this project to evaluate adherence to the perioperative hyperglycemic protocol among Certified Registered Nurse Anesthetists (CRNAs) at a large academic hospital. A secondary objective of this project is CRNAs' perceptions of barriers to point-of-care (POC) testing and the protocol. DesignA quality improvement project. MethodsUsing Donabedian's conceptual framework, a Phase 1 retrospective chart analysis of 297 patients with diabetes undergoing noncardiac surgery before and after implementing POC testing for intraoperative glucose control was performed. Only patients with preoperative BG ≥ 180 mg/dL were included in this phase of the project, which involved a comparison of the protocol utilization before and after implementation of POC testing. Phase 2 included an assessment of CRNA's perceptions of the protocol. FindingsThe final sample included 91 (37 preimplementation; 54 postimplementation) participants. There were no significant demographic differences between the groups. Overall, 52.7% of patients had intraoperative glucose checks, and only 16.5% received insulin. Preoperative BG levels decreased 11.4-points, and postoperative BG levels increased 20.4 points when comparing pre- and postimplementation groups. However, there were significant differences in postoperative glucose levels, pre- and postimplementation. The survey showed that the majority (65.5%) of CRNAs identified difficulty locating the protocol as the primary barrier to utilization. ConclusionsAlthough all patients included in this project qualified for an intraoperative glucose check, findings revealed that only half of the patients had a glucose check and less than one fifth of the patients received insulin treatment, indicating poor adherence to the protocol. Thus, while implementing protocols is essential, utilization and adherence to the protocol are critical to improving patient outcomes. Recommendations for continued improvement include increasing protocol accessibility, staff training, compliance monitoring, and a more simple protocol structure.

Recognition of symptoms, mitigating mechanisms and self-care experiences of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia

Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequence (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.

Recognition of symptoms, mitigating mechanisms and self-care experiences of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia

Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequence (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.

Recognition of symptoms, mitigating mechanisms and self-care experiences of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia

Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms of symptoms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequences (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.

Recognition of symptoms, mitigating mechanisms and self-care experiences of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia

Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms of symptoms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequences (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.

Thirst for Information and Needs Reflections of Type 2 Diabetes Patients Receiving Insulin Treatment in North-East Ethiopia: A Qualitative Exploration.

Objectives:Ongoing, proactive, planned, and patient-centered diabetes education is the cornerstone of care for all persons with diabetes. Thus, the aim of this study was to explore the information needs of type 2 diabetes mellitus patients receiving insulin treatment in North-East Ethiopia. Methods:The study was conducted from July 2019 to January 2020 using a qualitative enquiry (phenomenological approach) with purposive sampling. Face-to-face in-depth interviews were used to collect data until reaching theoretical saturation. The participants were type 2 diabetes patients receiving insulin treatment. They were identified from the diabetes patients’ registration book at the diabetes clinic and interviewed at their appointment time, and were selected to include wide variations in terms of socio-demographic characteristics. Twenty-four participants (11 men and 13 women), with a median age of 57 years, were interviewed. The data were organized using QDA Miner Lite version 2.0.7 and analyzed thematically using narrative strategies.Results:Most participants had not heard of diabetes before their diagnosis. They had limited knowledge of diabetes, but ascribed different connotations for it in the local language (Amharic). The needs reflections of patients were categorized into diabetes education and participants’ recommendations. Diabetes education was totally absent at hospitals, and patients received education primarily from the Ethiopian Diabetes Association and broadcast and digital media. Thus, the major concern of patients was the availability of diabetes education programs at health institutions.Conclusions:Patients’ main concern was the absence of routine diabetes education, which necessitates urgent action to implement diabetes education programs, especially at health institutions.

Evaluation of the Association of CGM Metrics with Antihyperglycemic Drugs in Insulin-Treated Diabetics

Introduction: Intermittent flash glucose monitoring (FGM) and real-time continuous glucose monitoring (CGM) are used to monitor glycemic excursions for 14 days and can demonstrate time in range (TIR), time above range (TAR), and time below range (TBR). The utility of CGM metrics, such as TIR, TBR, and TAR, in diabetics treated with insulin combined with antihyperglycemic drugs is uncertain. Methods: In a cross-sectional and retrospective study, we investigated the relationship between target metrics from CGM/FGM and HbA1c or glucose variabilities in 80 type 1 and 2 diabetic patients receiving insulin treatment with ≥1 injections per day. The proportions of TIR, TAR, and TBR from FGM in relation to HbA1c and coefficient of variation (CV)% in types 1 and 2 diabetics were analyzed. Multivariable analyses were performed regarding the associations of TIR with biochemical factors and glycemic variabilities. TBR was also examined in relation to antidiabetic agents and diabetic type in multiple regression analyses. Finally, the association of retinopathy with FGM-CGM metrics was examined using a logistic analysis. Results: When patients were grouped by sex and diabetic type, significant differences in age, TIR, TBR, high-density lipoprotein cholesterol (HDLC), and insulin dose were detected using Kruskal-Wallis analyses. HbA1c significantly correlated with TIR (p < 0.001) and TAR (p < 0.001) using Pearson’s correlation analysis. TBR significantly correlated with CV% (p < 0.001). Multivariable analysis of TIR showed a significant negative association with HbA1c (p = 0.02). Incretin combined with insulin therapy reduced the TBR proportion significantly according to the multivariate analysis. Retinopathy tended to be related to HbA1c (p = 0.059) and duration (p = 0.078) but not TIR (p = 0.891), according to the logistic analysis. Conclusions: These results demonstrate that CGM metrics reflect glucose control for 2 weeks using TIR. In addition, combined therapy with incretin and insulin therapy is superior for reducing hypoglycemia, based on TBR. Thus, TBR is also useful for monitoring hypoglycemia. However, FGM/CGM metrics do not predict retinopathy accurately.

Insulin treatment affects leukocyte telomere length in patients with type 2 diabetes: 6-year longitudinal study

ObjectiveMany studies demonstrated a close relationship between type 2 diabetes mellitus (T2DM) and leukocyte telomere length (LTL). However, how the LTL changes in T2DM and what are the potential causal factors in it, particularly in patients during a long period treatment, have not been studied. Here we performed a longitudinal observation of LTL in trained T2DM patients during a 6-year follow-up and evaluated the possible risk factors that were associated with LTL alteration. MethodsSeventy-six patients with T2DM were enrolled in this 6-year longitudinal study. The enrolled patients had no severe complication and had never received insulin therapy by the time. Patients were scheduled to visit once every one or two months and their medication changes were recorded. The LTL at the time when patients were enrolled was used as baseline, which was compared with the LTL at 6 year. Multivariable linear regression and exact logistic regression model were adopted to identify independent predictors of telomere length change and telomere length shortening, respectively. ResultsSixty-four patients were successfully followed up. Although mean LTL decreased after 6 years, 30% (19/64) of patients demonstrated LTL lengthening and 70% (45/64) of patients demonstrated LTL shortening. Among them, 18 Patients received insulin treatment during the 6 years. Of these 18 patients, 16 patients showed decreased LTL and only two showed increased LTL. Linear regression analysis demonstrated that change in telomere length during the 6 years was associated inversely with insulin use (β-coefficients: −0.587, 95% CI: −0.198, −0.085, P < 0.001). Exact logistic regression analysis showed insulin use (OR: 17.355, 95% CI: 2.659, 35.627, P = 0.013) and LDL-C(OR: 3.493, 95% CI: 1.559, 10.063, P = 0.007)were independent predicts of telomere length shortening. ConclusionsLTL may increase as well as decrease in T2DM who received antidiabetic treatment. Insulin use may accelerate telomere attrition. Insulin use and LDL-C can predict telomere shortening.

Angiostatin levels in diabetes mellitus patients receiving insulin treatment: associations with laboratory findings, comorbidities, and medications

The clinical effect of angiostatin in diabetes mellitus (DM) patients receiving insulin is a meaningful gap in the literature. In this study, we aimed to show the levels and the clinical significance of angiostatin in DM patients receiving insulin. This is a case-control study. Serum angiostatin levels were determined by ELISA. A total of 83 people consisting of healthy subjects (n = 36) and patients with a diagnosis of DM receiving insulin therapy (n = 47) were included in this study. The mean angiostatin levels of the DM group were significantly higher than those of the control group (86.0 ± 68.1 ng/mL and 58.0 ± 22.4 ng/mL, respectively; P = 0.011). Significantly lower angiostatin levels were determined in the DM patients receiving metformin with respect to those not receiving metformin (97.2 ± 74.4 ng/mL and 49.3 ± 7.0 ng/mL, respectively; P = 0.021). Significantly higher levels of angiostatin were observed among the DM patients using a beta-blocker (BB) than the DM patients not using a BB (115.5 ± 78.71 ng/mL and 73.44 ± 60.08 ng/mL, respectively; p = 0.029). This is the first study evaluating and demonstrating the serum angiostatin levels in DM patients receiving insulin. Further studies are required to understand the effect of angiostatin in diabetics and the effect of medications on angiogenesis in these patients.

Risk factors and complications in type 2 diabetes outpatients

Our study investigated type 2 diabetes mellitus (T2DM) outpatients attending a university hospital in Montes Claros, MG, to estimate the prevalence of risk factors and their association with diabetes complications. This was a quantitative, documental, retrospective and analytical study. Medical records of 95 outpatients with T2DM treated in this hospital from 2011 to 2015 were analyzed. Data were collected according to a structured questionnaire surveying sociodemographic, anthropometric and biochemical data and clinical and lifestyle aspects. Regression analysis was used to evaluate the association between risk factor variables and complications. With a mean age of 54 years, the study population showed irregular blood glucose control, despite the use of hypoglycemic medication, and did not have a healthy lifestyle. The main complication reported was high blood pressure (HBP), occurring in 70.9% of patients. The prevalence of complications was positively associated with patients receiving insulin treatment (p=0.042) and multidisciplinary monitoring (p=0.050). The associations identified reflect the condition of patients that were already treating diabetes and its complications, especially HBP. The characteristics of the study population indicate the need to improve clinical follow-up and increase motivation for healthy behaviors.

Meta-analysis of the insulin dosage in Chinese type 2 diabetes patients receiving insulin treatment

Meta-analysis of the insulin dosage in Chinese type 2 diabetes patients receiving insulin treatment

Glycemic control and self-monitoring of blood glucose in Chinese patients with type 2 diabetes on insulin: Baseline results from the COMPASS study

AimsSelf monitoring of blood glucose (SMBG) is not widely utilized in insulin-treated patients with type 2 diabetes. In this analysis, we evaluated the current state of SMBG in Chinese adults with type 2 diabetes treated with insulin. MethodsThe 2-phase COMPASS study involved 24 centers across 10 provinces and cities in China. In the first phase, a cross sectional survey was carried out in type 2 diabetes patients receiving insulin treatment. The inclusion criteria for the study subjects in the first phase were: type 2 diabetes, insulin treatment for ≥3 months, and age ≥18 years. Evaluation was made on the status of SMBG and insulin therapy in these patients by a questionnaire. ResultsA total of 2819 patients (age 58.2±10.8 years; 49.6% females; BMI 24.6±3.4kg/m2) with insulin-treated type 2 diabetes were recruited in phase I of this study. The majority of patients (80.4%) were receiving insulin treatment for at least 6 months. At baseline, the mean HbA1c was 8.5±1.9% and 54.6% of patients had an HbA1c above 8%. 50.4% of the cohort had diabetes for at least 10 years, and fewer of these patients achieved HbA1c <7.0% (53mmol/mol). At baseline, 65.8% of patients reported that daily SMBG frequency was performed on a random basis. 59.2% of patients reported that they occasionally, rarely or never follow their physician's instructions regarding SMBG. Hypoglycemia occurred in over 50% of patients, although in 71.8% of patients this was a rare occurrence. ConclusionsThere is low utilization of SMBG in Chinese adults with insulin-treated type 2 diabetes, with approximately two-thirds of patients reporting irregular use of SMBG. This is in line with an overall poor level of glycemic control.

PP.05.18

Objective: Cardiovascular diseases represent the mortality main cause in diabetic population. To evaluate prevalence and control of Diabetes Mellitus (DM) in patients admitted to the emergency room due to an acute vascular event. Design and method: We analyzed retrospectively 3635 patients (65,5% men) with a mean age of 71,15 (SD:12,6) that were admitted to the emergency room consecutively since January 2009 until December 2011 due to an acute vascular event; acute coronary syndrome (ACS), stroke or peripheral acute arterial disease (PAD). Patients were classified in two groups: those with known DM (n = 1265) and patients with not known diabetes mellitus, NDM (n = 2253). Results: DM group had elderly patients [72,9 (SD:9,8) vs. 70,1(SD:13,9)*]. DM group presented more ACS (47,7 vs. 43.5%*) and PAD (21 vs. 11,5%*) and an inferior ratio of Stroke (31,3 vs. 44,9*). HbA1C was performed in 881 patients (66,3%) in the DM group and 1024(44.4%) in NDM group. 18,1% (186 patients) with not known diabetes mellitus presented a HbA1C > 6,5%. DM patients receiving insulin treatment had worse controls than patients with oral treatment (8.0 vs. 7.6 % p > 0.05). In-hospital mortality was greater in DM patients than in NDM (11.0% vs. 9.6% *). (* p < 0.01). Conclusions: Prevalence of Diabetes Mellitus was high (34.8%). From the not known diabetic patients group a 18% had a recent diagnose of diabetes with an HbA1c > 6,5%. This test should be performed in all patients that are admitted due to an acute vascular event. Patients on oral antidiabetic agents presented better controlled than patients receiving insulin but differences were not statistically significant. In-hospital mortality was greater in diabetic population than in non-diabetic patients.

Strategies for management of diabetes in the young in China

The incidence of type 1 diabetes mellitus (T1DM) is rising rapidly in children, with an overall annual global increase of 3%. Approximately 79,100 children under age 15 develop T1DM annually. Although the reported incidence of T1DM in China was as low as 0.6 per 100,000 per annum in 1995, the number of children with T1DM cannot be underestimated within the large population. The number of type 2 diabetics in the young has been increasing significantly in the last decades. To improve access to quality care for children with diabetes in China, the World Diabetes Foundation (WDF) planned a project to help to establish pediatric diabetes centers to increase the rate of diagnosis and to improve the quality of treatment for children with diabetes through training of health care professionals. A survey was conducted on the basis of pediatric diabetes centers across China to raise the awareness of pediatric diabetes, and to evaluate the diagnosis and treatment status of diabetes care in children. Multiple diabetes camps were organized for children and caregivers. The project commenced in December 2012 and will be completed in February 2015. Thirty three pediatric diabetes centers in 25 cities across China were established. A cross-sectional questionnaire survey about the children with diabetes was completed. Until the end of December 2013, 1,224 children with T1DM were effectively enrolled into the program with a mean age of 7.28±3.75 (mean± SD). For the age distribution, 79% were in the range of 4-12 years old, of those 384 cases were younger than 5 and 840 cases were older than 5 years old. The male to female ratio was 46.8% to 53.2%. 49% of the patients presented with typical diabetic symptoms such as increased thirst, frequent urination, extreme hunger, weight loss and fatigue. 59.3% cases first presented with diabetic ketoacidosis (DKA). The overall incidence of hypoglycemia was 17.5% (20.3% in 0.05y). The total incidence of DKA was 59.3% (57.4% in 0.05). The average level of HbA1c was (11.1±3.2)%. Using HbA1c 7.5% as a cut-off, the incidence of hypoglycemia was 29.3% in the HbA1c below 7.5% group and 14.2% in the above 7.5% group (P 0.05). 97.2% of the patients received insulin treatment, while 83.3% with insulin injection and 14% adopted pump therapy. 78.8% of the patients were using multiple insulin injection regimes. In China, T1DM is still the major form of diabetes among the young, although there is a tendency of increasing T2DM. Greater efforts need to be made to improve the awareness and quality of care. A task fprce on diabetes in children was recently formed by the Chinese Society of Pediatric Endocrinology and Metabolism (CSMEM) to facilitate nationwide research and collaboration.

Cost Effectiveness Analysis of Flash Glucose Monitoring for Type 2 Diabetes Patients Receiving Insulin Treatment In The Uk

Cost Effectiveness Analysis of Flash Glucose Monitoring for Type 2 Diabetes Patients Receiving Insulin Treatment In The Uk

Medical, psychological and social features in a large cohort of adults with Prader–Willi syndrome: experience from a dedicated centre in France

Prader-Willi syndrome (PWS) is a developmental genetic disorder characterised by a variable expression of medical, cognitive and behavioural symptoms. In adulthood, the prevalence and severity of these symptoms determine the quality of life of the affected persons. Because of their rare disease condition, data on health and social problems in adults with PWS are scarce. In this research, we present medical, psychological and social features of a large cohort of adults admitted to a specialised PWS centre in France and analyse the differences according to genotype, gender and age. Data from 154 patients (68 men/86 women), with a median age of 27 years (range 16-54), were collected during their stay in our centre. Clinical histories were completed using information from parents or main caregivers, and the same medical team performed the diagnosis of different clinical conditions. Statistical analyses were performed to determine the influence of factors such as genotype, age or gender. Paternal deletion genotype was the most frequent (65%) at all ages. Most patients had mild or moderate intellectual disability (87%). Only 30% had studied beyond primary school and 70% were in some special educational or working programme. Most of them lived in the family home (57%). The most prevalent somatic comorbidities were scoliosis (78%), respiratory problems (75%), dermatological lesions (50%), hyperlipidaemia (35%), hypothyroidism (26%), Type 2 diabetes mellitus (25%) and lymph oedema (22%). Some form of psychotropic treatment was prescribed in 58% of subjects, and sex hormones in 43%. Patients with deletion had a higher body mass index (44 vs. 38.9 kg/m(2)) and displayed higher frequency of sleep apnoeas. Non-deletion patients received insulin treatment (19% vs. 4%) and antipsychotic treatment (54.8% vs. 32.7%) more frequently. No difference was observed in the prevalence of Type 2 diabetes between the two genotype groups. Patients >27 years of age had a higher rate of comorbidities (Type 2 diabetes, hypertension, respiratory problems and lymph oedema). Gender differences were minor. Adult patients with PWS showed high prevalence of comorbid health problems that need to be monitored for early treatment. Some of them are influenced by genotype and age. Another salient problem concerns the lack of adapted structures for better social integration. Further data about the real life and health conditions of adults with PWS are necessary to further our knowledge of the natural history of the disease and to design appropriate care strategies.

Stress hyperglycemia, insulin treatment, and innate immune cells.

Hyperglycemia (HG) and insulin resistance are the hallmarks of a profoundly altered metabolism in critical illness resulting from the release of cortisol, catecholamines, and cytokines, as well as glucagon and growth hormone. Recent studies have proposed a fundamental role of the immune system towards the development of insulin resistance in traumatic patients. A comprehensive review of published literatures on the effects of hyperglycemia and insulin on innate immunity in critical illness was conducted. This review explored the interaction between the innate immune system and trauma-induced hypermetabolism, while providing greater insight into unraveling the relationship between innate immune cells and hyperglycemia. Critical illness substantially disturbs glucose metabolism resulting in a state of hyperglycemia. Alterations in glucose and insulin regulation affect the immune function of cellular components comprising the innate immunity system. Innate immune system dysfunction via hyperglycemia is associated with a higher morbidity and mortality in critical illness. Along with others, we hypothesize that reduction in morbidity and mortality observed in patients receiving insulin treatment is partially due to its effect on the attenuation of the immune response. However, there still remains substantial controversy regarding moderate versus intensive insulin treatment. Future studies need to determine the integrated effects of HG and insulin on the regulation of innate immunity in order to provide more effective insulin treatment regimen for these patients.

Associations of metabolic syndrome and diabetes mellitus with 16-year survival after CABG

BackgroundThe associations of metabolic syndrome (MetS) or diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) have not been extensively evaluated. The aim of the present study was to assess the impact of MetS and DM on the 16-year survival after CABG.MethodsDiabetic and metabolic status together with relevant cardiovascular data was established in 910 CABG patients operated in 1993-94. They were divided in three groups as follows: neither DM nor MetS (375 patients), MetS alone (279 patients) and DM with or without MetS (256 patients). The 16-year follow-up of patient survival was carried out using national health databases. The relative survival rates were analyzed using the Life Table method comparing the observed survival rates of three patient groups to the rates based on age-, sex- and time-specific life tables for the whole population in Finland. To study the independent significance of MetS and DM for clinical outcome, multivariate analysis was made using an optimizing stepwise procedure based on the Bayesian approach.ResultsBayesian multivariate analysis revealed together six variables to predict clinical outcome (2 months to 16 years) in relation to the national background population, i.e. age, diabetes, left ventricular ejection fraction, BMI, perfusion time during the CABG and peripheral arterial disease. Our principal finding was that after postoperative period the 16-year prognosis of patients with neither DM nor MetS was better than that of the age-, sex-and time-matched background population (relative survival against background population 1.037, p < 0.0001). The overall survival of MetS patients resembled that of the matched background population (relative survival 0.998, NS). DM was associated with significantly increased mortality (relative survival 0.86, p < 0.0001). Additionally, mortality was even higher in patients receiving insulin treatment than in those without. Excess death rate of DM patients was predominantly caused by cardiovascular causes.ConclusionIn this long-term follow-up study patient groups without diabetes had at least equal 16 years’ survival after CABG than their matched background populations. Survival of DM patients started to deteriorate already few years after the operation.