Receiving Insulin Treatment Research Articles

Factors Associated With Initiation of Antidepressant Medication in Adults With Type 1 and Type 2 Diabetes: A Primary Care Retrospective Cohort Study in Ontario, Canada

ObjectivesDepression in patients with diabetes mellitus is common and associated with poorer outcomes. This study aims to identify demographic, socioeconomic and medical factors associated with the initiation of antidepressant medication after a diagnosis of diabetes in adult patients without a previous prescription for antidepressants. We also examined frequency of primary care visits in the year after antidepressant initiation compared with the year before treatment began. MethodsThis was a retrospective cohort study using routinely collected electronic medical record data spanning January 2011 to December 2019 from the University of Toronto Practice-based Research Network (UTOPIAN) Data Safe Haven. Our primary outcome was a first prescription for an antidepressant in patients with diabetes. We used a mixed-effects logistic regression model to identify sociodemographic and medical factors associated with this event. ResultsAmong 22,750 patients with diabetes mellitus, 3,055 patients (13.4%) began taking an antidepressant medication. Increased odds of antidepressant initiation were observed in younger patients (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.39 to 2.26), females (OR, 1.60; 95% CI, 1.46 to 1.7), those receiving insulin treatment (OR, 1.59; 95% CI, 1.43 to 1.78) and cases of polypharmacy (OR, 3.67; 95% CI, 3.29 to 4.11). There was an increase in the mean number of primary care visits from 4.6 to 5.9 per year after antidepressant initiation. ConclusionsIn patients with diabetes, age, sex and medical characteristics were associated with the initiation of antidepressants. These patients accessed primary care more frequently. Screening and prevention of depression, particularly in these subgroups, could reduce its personal and systemic burdens.

The effect of human recombinant epidermal growth factor in the treatment of diabetic foot ulcers

Objectives. Diabetic foot ulcer (DFU) is one of the most important and common complication of type 2 diabetes mellitus (T2DM). A new therapy, consisting of intralesional administration of human recombinant epidermal growth factor (hrEGF), has been suggested to accelerate wound healing and prevent amputations. The effect of hrEGF on DFU treatment was investigated in this study. Materials and Methods. 20 patients with DFU were included in this study, all of whom were receiving insulin treatment for T2DM. In addition, they received intralesional therapy with a dose of 75 μgr of hrEGF, three times a week. Results. In 18 patients, complete granulation response was achieved in approximately 3,3 weeks. There were 2 cases of recurrence at 6 months after EGF treatment. Between 6 and 12 doses of epidermal growth factor were used for this study. The most common side effects were tremor, chills, pain and burning at the site of administration. Conclusions. Our study shows that intralesional administration of hrEGF in T2DM can prevent amputations in DFU and also accelerate wound healing. Thus, intralesional application of hrEGF should be an option for standard care, as a second line of treatment (given its cost-effectiveness) when appropriate.

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.

Prediction of insulin therapy in women with gestational diabetes: a systematic review and meta-analysis of observational studies.

To identify antenatal risk factors that may predict the need for insulin treatment upon diagnosis of gestational diabetes (GDM), that is, to identify the specific characteristics of women diagnosed with GDM who did not achieve good glycemic control through lifestyle modifications. We performed a comprehensive literature search in PubMed, Science Direct, Ebsco, and Scielo for studies evaluating the associations between antenatal factors and the need for insulin treatment published until January 28th, 2021. Random-effects models were used to estimate risk ratios and their 95% confidence interval. The quality of studies was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to estimate outcomes, and effects reported as risk ratio and their 95% confidence interval. The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews. Eighteen observational studies were selected, reporting 14,951 women with GDM of whom 5,371 received insulin treatment. There were statistically significant associations between the need for insulin treatment and BMI≥30 (RR:2.2; 95%CI: 1.44-3.41), family history of type2 diabetes mellitus (RR:1.74; 95%CI: 1.56-1.93), prior personal history of GDM (RR:2.10; 95%CI: 1.56-2.82), glycated hemoglobin value at GDM diagnosis (RR:2.12; 95%CI: 1.77-2.54), and basal glycemia obtained in the diagnostic curve (RR: 1.2; 95%CI: 1.12-1.28). Nulliparity and maternal age were not determinants factor. There was moderate-to-high heterogeneity among the included studies. the strong causal association between BMI≥30, family history of type 2 diabetes mellitus, prior history of GDM and glycosylated hemoglobin with the need for insulin treatment was revealed.

Adjuvant Probiotics of Lactobacillus salivarius subsp. salicinius AP-32, L. johnsonii MH-68, and Bifidobacterium animalis subsp. lactis CP-9 Attenuate Glycemic Levels and Inflammatory Cytokines in Patients With Type 1 Diabetes Mellitus.

IntroductionType 1 diabetes mellitus (T1DM) is characterized by autoimmune destruction of pancreatic β cells. Previous study has discovered that probiotic strains residing in the gut play essential roles in host immune regulation. However, few clinical results demonstrated probiotic would actually benefit in attenuating glycated hemoglobin (HbA1c) along with inflammatory cytokine levels of the T1DM patients and analyzed their gut microbiota profile at the same time. In this clinical trial, we evaluated the therapeutic efficacy of probiotics on HbA1c along with inflammatory cytokine levels of T1DM patients to determine an alternative administration mode for T1DM medication. The probiotics changed T1DM gut microbiota profile will be measured by next-generation sequencing (NGS).Research Design and MethodsA randomized, double-blind, placebo-controlled trial was performed at China Medical University Hospital. T1DM patients between 6 and 18 years of age were enrolled. 27 patients were administered regular insulin therapy plus capsules containing probiotic strains Lactobacillus salivarius subsp. salicinius AP-32, L. johnsonii MH-68, and Bifidobacterium animalis subsp. lactis CP-9 daily for 6 months, and 29 patients were administered insulin therapy without extra probiotic supplement as placebo group. The variations of fasting blood glucose and HbA1c in these patients were analyzed. In addition, serum levels of inflammatory cytokines and anti-inflammatory cytokine were assessed using enzyme-linked immunosorbent assay. Patients’ stool microbiota were all subjects to NGS analysis.ResultsNGS data showed elevated populations of Bifidobacterium animalis, Akkermansia muciniphila and Lactobacillus salivarius in the gut of patients with T1DM who were taking probiotics. Patients with T1DM who were administered probiotics showed significantly reduced fasting blood glucose levels compared with the before-intervention levels. The HbA1c levels of the patients also improved after administration of probiotics. The concentrations of IL-8, IL-17, MIP-1β, RANTES, and TNF-α were significantly reduced and were associated with an increased TGF-β1 expression after probiotic intervention. The persistence effect of glycemic control and immunomodulation were observed even 3 months after discontinuation of the probiotics.ConclusionsHere, we found that conventional insulin therapy plus probiotics supplementation attenuated T1DM symptoms than receiving insulin treatment only. Probiotics supplementation with insulin treatment changed gut microbiota and revealed better outcome in stabilizing glycemic levels and reducing HbA1c levels in patients with T1DM through beneficial regulation of immune cytokines. Clinical Trial Registration ClinicalTrials.gov, identifier NCT03880760.

Fetal cardiac morphology and geometry in pregnancies with class A1 and A2 gestational diabetes mellitus

Objective To evaluate whether certain parameters on fetal cardiac morphology and geometry measured at 20–22 weeks of gestation differ in subsequently diagnosed gestational diabetes mellitus (GDM) pregnancies and whether these changes are associated with disease severity as indicated by class A1 and A2 GDM. Method It was designed as a retrospective study. All measurements were taken between 20 and 22 weeks of gestation. We compared fetal cardiac structural measurements of 200 uncomplicated pregnancies (control group) with those of 307 GDM patients (160 of the them were regulated with diet (GDM A1) and 147 of them received insulin treatment (GDM A2) during pregnancy). GDM were diagnosed between 24-28 weeks of gestation with 75 gram (g) oral glucose tolerance test. Results The interventricular septum (IVS) was thicker in both in GDM A2 and GDM A1 than control (p < .001, p < .001), and there was statistically significant difference between GDM A2 and GDM A1 (p = .012). In both left and right wall thickness in GDM A1 and GDM A2 were remarkably higher than control group (p < .001, p < .001, p < .001, p < .001). The left and right spherical indices were higher in both GDM A1 and GDM A2 groups than controls (p = .021 and p = .028). Left and right area in GDM A1 and GDM A2 groups were significantly smaller than control groups (p < .001 and p = .001). Conclusion Gestational diabetes is a common obstetric morbidity, which causes fetal cardiac structural changes. Our study shows that these changes can occur during the early weeks of pregnancy.

Young-onset diabetes patients in Thailand: Data from Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN).

ABSTRACTAims/IntroductionThere is a lack of current information regarding young‐onset diabetes in Thailand. Thus, the objectives of this study were to describe the types of diabetes, the clinical characteristics, the treatment regimens and achievement of glycemic control in Thai patients with young‐onset diabetes.Materials and MethodsData of 2,844 patients with diabetes onset before 30 years‐of‐age were retrospectively reviewed from a diabetes registry comprising 31 hospitals in Thailand. Gestational diabetes was excluded.ResultsBased on clinical criteria, type 1 diabetes was identified in 62.6% of patients, type 2 diabetes in 30.7%, neonatal diabetes in 0.8%, other monogenic diabetes in 1.7%, secondary diabetes in 3.0%, genetic syndromes associated with diabetes in 0.9% and other types of diabetes in 0.4%. Type 1 diabetes accounted for 72.3% of patients with age of onset <20 years. The proportion of type 2 diabetes was 61.0% of patients with age of onset from 20 to <30 years. Intensive insulin treatment was prescribed to 55.2% of type 1 diabetes patients. Oral antidiabetic agent alone was used in 50.8% of type 2 diabetes patients, whereas 44.1% received insulin treatment. Most monogenic diabetes, secondary diabetes and genetic syndromes associated with diabetes required insulin treatment. Achievement of glycemic control was identified in 12.4% of type 1 diabetes patients, 30% of type 2 diabetes patients, 36.4% of neonatal diabetes patients, 28.3% of other monogenic diabetes patients, 45.6% of secondary diabetes patients and 28% of genetic syndromes associated with diabetes patients.ConclusionIn this registry, type 1 diabetes remains the most common type and the prevalence of type 2 diabetes increases with age. The majority of patients did not achieve the glycemic target, especially type 1 diabetes patients.

Disturbed gastric motility in patients with long-standing diabetes mellitus

Purpose: Gastric dysmotility has been reported in patients with long-standing diabetes mellitus (DM). Some patients with DM are diagnosed as diabetes gastroparesis and have several upper gastrointestinal (GI) symptoms such as appetite loss and abdominal pain. This study aimed to identify the relationship between gastric motility and upper GI symptoms in patients with long-standing DM. Method: This study was conducted among 23 patients with DM and 15 healthy controls. All the patients with DM were receiving insulin treatment and had at least one history of incidence of diabetic nephropathy, retinopathy or neuropathy. Gastric motility was evaluated using electrogastrography (EGG) and gastric emptying using the 13C-acetic acid breath test. The most severe upper gastrointestinal symptoms were assessed in all patients. Results: Compared to healthy controls, patients with long-standing DM showed a significantly lower percentage of normogastria at the postprandial state with a lower power ratio in EGG. Gastric emptying was significantly delayed in patients with DM in the overall analysis. Sixteen patients with DM (69.6%) demonstrated abnormalities in either gastric myoelectrical activity or gastric emptying. Among patients with abnormal EGG or delayed gastric emptying, 12 had some GI symptoms, compared with 3 patients with normal gastric motility. No significant correlation was observed between the gastric emptying parameters and HbA1c values. Conclusion: Patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appears to be closely correlated with upper GI symptoms in patients with long-standing DM.

Clinical cost evaluation and health benefits of post-bariatric intervention for patients with type 2 diabetes living in the UK.

To assess associated healthcare costs and risk of developing obesity-related comorbidities among patients with type 2 diabetes with severe obesity and receiving insulin treatment, following bariatric surgery (BS). A retrospective cohort study was conducted from a UK electronic primary care database. Propensity score matching (1:1) was performed for BS with non-BS cohort. Follow-up was over 5 years (694 person-years), comparing drug utilization with clinical cost differences, such as visits to General practitioners (GPs), hospitalization, and laboratory use. Cox proportional regression was used to compute differences in the risk of obesity-related comorbidities and chi-square analysis to explore differences in insulin independency and diabetes remission proportions during follow-up. Eighty patients who received BS were matched to 80 non-BS (N=160). The baseline mean age was 48.3 years (SD: 12.9) (61% female), and body mass index was 39.3kg/m2 (SD: 9.3). During follow-up, antidiabetic drug cost was significantly lower in the BS group than in the non-BS (median cost/person [£]: 527.77 [interquartile range (IQR): 1196.11] vs. 1564.13 [IQR: 1576.01]; p < 0.001). Overall, aggregate cost analysis showed a significant total healthcare cost reduction in the BS group (median cost/person [£]: 1597.96 [IQR: 2631.84] vs. 2440.12 [IQR: 2242.95]; p=0.050). BS significantly protected against obesity-related comorbidities compared with the non-BS (adjusted hazard ratio: 0.56; 95% confidence interval: 0.32-0.96; p=0.036) and increased insulin independency throughout all follow-up points: at year 5: 48.1% versus 28.9%; p=0.044, respectively. While BS shows evidence of cost efficiency, cost saving was not identified. The efficiency is evident by the protective effect against crude obesity-related comorbidities associated with increased insulin independency.

Risk assessment and classification for foot ulceration among patients with type 2 diabetes in South Korea.

This study aimed to investigate the distribution of foot conditions, the risk of foot ulceration and its associated factors in patients with diabetes. Few studies have focused on the risk of foot ulceration in patients with diabetes. A total of 267 patients with diabetes who attended outpatient clinics in two tertiary referral hospitals were recruited from June to September 2016. The risk of foot ulceration was classified using the American Diabetes Association (ADA), International Working Group on the Diabetic Foot (IWGDF) and Scottish Intercollegiate Guidelines Network (SIGN) classification systems. The risk categories of each system were reclassified into high- (categories of 2 and 3 for the ADA and IWGDF systems and high for the SIGN system) and low-risk. Foot deformity was the most prevalent condition (38.2%). Among 261 patients without active ulcers, between 17.6% to 35.2% were classified in the high-risk group and overall agreement among systems ranged from .42 to .56 of the kappa statistic. Insulin treatment was consistently associated with a high-risk of foot ulceration. As the risk varies between systems, nurses should select a suitable classification system through validation studies and assess the risk in patients with diabetes, particularly, those receiving insulin treatment.

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.

Hsa_circ_0054633 association of C peptide is related to IL-17 and TNF-α in patients with diabetes mellitus receiving insulin treatment.

BackgroundChronic inflammation damaged the islet and resulted in dysfunction of T2D. Circular RNA is stable and better for biomarker in many diseases. Here, we aimed to identify potential circular RNA hsa_circ_0054633 that can be a biomarkers for the effects of insulin therapy in T2D.MethodsIn this retrospective case‐control study, patients were from Li Huili Hospital, Ningbo, China, from February 10, 2019, to August 15, 2019. We included 47 healthy adults, 46 new‐onset T2D with insulin resistance, and 51 patients with insulin therapy. Serum inflammation factors were tested by ELISA assays. We selected hsa_circ_0054633 as a candidate biomarker and measured its concentration in serum by qRT‐PCR. The Pearson correlation test was used to evaluate the correlation between this circRNA and clinical variables.ResultsClinical data indicated that serum C peptide was increased in T2D treatment with insulin. Serum hsa_circ_0054633 was decreased in insulin treatment group. Hsa_circ_0054633 was negative correlated with C peptide (r = −0.2841, p = 0.0433,). IL‐1 and IL‐6, IL‐17, and TNF‐α were higher in T2D patients and decreased after insulin treatment, only IL‐17 and TNF‐α showed a positive correlation to hsa_circ_0054633 (r = 0.4825, p < 0.0001, and r = 0.6190, p < 0.0001). The area under ROC curve was 0.7432, 0.5839, and 0.7573 for Hsa_circ_0054633, C peptide, and their combination.ConclusionHsa_circ_0054633 level was lower in T2D with insulin treatment than untreated and was a negative correlation with C peptide, and positively correlated with IL‐17 and TNF‐α, suggesting that hsa_circ_0054633 may be a potential early indicator of insulin treatment effect to improve inflammation condition.

Insulin-producing cells from bone marrow stem cells versus injectable insulin for the treatment of rats with type I diabetes

Recently, stem cells have been considered renewable cell sources in the treatment of diabetes and the development of insulin-producing cells. In this regard, the current study aimed to compare Insulin-producing cells from bone marrow stem cells with injectable insulin in rats with type I diabetes. For this purpose, 40 rats were divided into four groups: the control or healthy group, the diabetic control group, the group that received differentiated insulin-producing cells from bone marrow, and the group that received insulin treatment. To differentiate insulin-producing cells from bone marrow, the femoral bone marrow of rats was extracted using the flushing method. Differentiated cells were evaluated using dithizone-specific dye, anti-insulin-proinsulin antibodies, and anti-insulin beta receptors. Also, the expression of the pdx-I gene, as the specific gene of pancreatic cells, was examined by RT-PCR. The results showed that transplantation of insulin-producing cells could significantly increase blood insulin levels in diabetic rats. This increase intensified in the second stage of transplantation when more cells were injected into rats. Concerning decreasing blood sugar levels, differentiated cells were able to reduce blood sugar levels significantly. Even in the first stage of cell injection, in which the rats received a small number of cells, their blood sugar levels were controlled by these cells. As a result, the present study showed that repeated transplants of insulin-producing cells differentiated from bone marrow could decrease blood sugar and increase insulin levels.

172-LB: Identification of Specific Risk Factors for Mortality in Patients with Diabetes Mellitus Hospitalized with COVID-19

Introduction: Several studies have shown that diabetes mellitus (DM) is a risk factor for in hospital mortality due to COVID-19. The aim of our study was to analyze if prior clinical characteristics among DM patients affected the risk of in hospital mortality compared with nondiabetic patients hospitalized with COVID-19. Material and Methods: The study was based on a retrospective, observational design and was conducted at two hospitals located in Albacete (Spain). All patients hospitalized with COVID-19 since the start of the pandemic until 7 July 2020 were included. Results: During the study period, 1468 patients were hospitalized due to COVID-19; 402 of them had DM prior to hospitalization. DM was associated with higher in hospital mortality (28.6% versus 17.5%) in the univariate analysis. But, in a multivariate logistic regression analysis, after adjusting for age, presence of hypertension, smoking, presence of COPD, ACEI, ARB, antiplatelet, or anticoagulant therapy, DM was not a significant risk factor for death. Patients with DM2 receiving insulin treatment had a higher risk of in hospital death than nondiabetic patients (OR 1.78 [1.13-2.81], p=0.0126) after age was considered. The age-associated relative risk was 1.06 (1.05-1.07, p&amp;lt;0.001) per year, whereas the relative risk associated with DM2 treated with insulin compared with no DM was 1.57 (1.11-2.23, p=0.0111) suggesting that DM2 treated with insulin entails a risk of in hospital COVID-19 death equivalent to being 9 years older. When previous logistic regression models included other variables related to personal history and prior nondiabetic treatments, the risks described showed no change. Conclusion: This study confirms that pre-admission need for insulin therapy before hospitalization in patients with DM2 are associated with higher in hospital mortality due to COVID-19 in a large sample of DM inpatients with COVID-19. Disclosure P. J. Pinés-corrales: None. M. Molina: None. L. García-blasco: None. R. Quilez toboso: None. M. Alcaraz: None. L. Vicente gutiérrez: None. G. Paterna mellinas: None. J. Calbo mayo: None. J. Alfaro-martínez: None.

Insulin Management of Patients with Inadequately Controlled Type 2 Diabetes Admitted to Hospital: Titration Patterns and Frequency of Hypoglycemia as Results of a Prospective Observational Study (Hospital Study)

IntroductionDespite the continuously growing number of therapeutic options for type 2 diabetes mellitus (T2DM) including insulins, a large percentage of patients fail to achieve HbA1c targets. Several real-world studies focused on patients with T2DM receiving insulin treatment in outpatient settings were conducted, but information about real-world in-hospital insulin management is lacking. The aim of this study was to describe the management of insulin therapy with a focus on basal-bolus and premixed insulin regimens in patients with T2DM under routine in-hospital medical practice in the Czech Republic.MethodsThis non-interventional prospective study was conducted from June 2014 to December 2017 in 22 centers in the Czech Republic under routine clinical practice conditions. Adult patients admitted to hospital with metabolically uncontrolled T2DM [HbA1c ≥ 60 mmol/mol; > 7.6% Diabetes Control and Complications Trial (DCCT)] and there treated with basal-bolus and premixed insulin regimens were documented during hospitalization.ResultsOverall, 369 patients with T2DM (54.7% male, mean age 64.44 ± 13.84 years, BMI 31.10 ± 6.00 kg/m2, duration of diabetes 8.11 ± 9.93 years, HbA1c 95.90 ± 24.38 mmol/mol, length of stay was 7.94 ± 4.53 days) were included. The percentage of glucose values under 10 mmol/l at time of randomization (the group with basal-bolus insulin regimen vs. the premix insulin regimen group) was 24.2% vs. 33.5% (p = 0.053), at time of first insulin dose adjustment it was 43.1% vs. 50.0% (p = 0.330), and 1 day before hospital discharge it was 61.7% vs. 61.4% (p = 0.107). A hypoglycemic event occurred in a total of 15 patients in the basal-bolus regimen group, and no hypoglycemic event occurred in the premixed insulin regimen group.ConclusionIn-hospital insulin management regarding basal-bolus and premixed insulin regimens is safe and in concordance with current international recommendations.

Islet transplantation ameliorates diabetes-induced testicular interstitial fibrosis and is associated with inhibition of TGF-β1/Smad2 pathway in a rat model of type 1 diabetes.

Islet transplantation (IT) is considered the most effective endocrine replacement therapy for diabetes mellitus (DM). Studies have demonstrated that IT can repair testicular structural injury caused by inflammatory and oxidative stress in a diabetic rat model. However, highly effective exogenous antioxidant and anti-inflammatory drugs can achieve this effect. Testicular interstitial fibrosis caused by long-term hyperglycemia is however difficult to reverse or recover. Thus far, there are no effective drugs that prevent or relieve testicular interstitial fibrosis. Therefore, it is necessary to explore the potential benefit of IT on testicular interstitial fibrosis induced by DM and its underlying molecular mechanisms. In the present study, Wistar rats were used to establish a DM model by intraperitoneal injection of streptozotocin. The diabetic models then underwent IT or received insulin treatment after 12 weeks. IT was more effective than insulin treatment in ameliorating diabetic-induced testicular interstitial fibrosis, Leydig cells apoptosis, testosterone deficiency and poor sperm motility. IT and insulin treatment both significantly inhibited the upregulation of TGF-β1 and phosphorylated Smad2 in DM, with IT being more effective than insulin. The present study's findings proved that IT effectively protects diabetic-induced testicular interstitial fibrosis probably by inhibiting the TGF-β1/Smad2 signaling pathway, which offers hope in male patients with DM complicating with testicular interstitial fibrosis.

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.

Treatment-Induced Neuropathy in Diabetes (TIND)-Developing a Disease Model in Type 1 Diabetic Rats.

Treatment-induced neuropathy in diabetes (TIND) is defined by the occurrence of an acute neuropathy within 8 weeks of an abrupt decrease in glycated hemoglobin-A1c (HbA1c). The underlying pathogenic mechanisms are still incompletely understood with only one mouse model being explored to date. The aim of this study was to further explore the hypothesis that an abrupt insulin-induced fall in HbA1c may be the prime causal factor of developing TIND. BB/OKL (bio breeding/OKL, Ottawa Karlsburg Leipzig) diabetic rats were randomized in three groups, receiving insulin treatment by implanted subcutaneous osmotic insulin pumps for 3 months, as follows: Group one received 2 units per day; group two 1 unit per day: and group three 1 unit per day in the first month, followed by 2 units per day in the last two months. We serially examined blood glucose and HbA1c levels, motor- and sensory/mixed afferent conduction velocities (mNCV and csNCV) and peripheral nerve morphology, including intraepidermal nerve fiber density and numbers of Iba-1 (ionized calcium binding adaptor molecule 1) positive macrophages in the sciatic nerve. Only in BB/OKL rats of group three, with a rapid decrease in HbA1c of more than 2%, did we find a significant decrease in mNCV in sciatic nerves (81% of initial values) after three months of treatment as compared to those group three rats with a less marked decrease in HbA1c <2% (mNCV 106% of initial values, p ≤ 0.01). A similar trend was observed for sensory/mixed afferent nerve conduction velocities: csNCV were reduced in BB/OKL rats with a rapid decrease in HbA1c >2% (csNCV 90% of initial values), compared to those rats with a mild decrease <2% (csNCV 112% of initial values, p ≤ 0.01). Moreover, BB/OKL rats of group three with a decrease in HbA1c >2% showed significantly greater infiltration of macrophages by about 50% (p ≤ 0.01) and a decreased amount of calcitonin gene related peptide (CGRP) positive nerve fibers as compared to the animals with a milder decrease in HbA1c. We conclude that a mild acute neuropathy with inflammatory components was induced in BB/OKL rats as a consequence of an abrupt decrease in HbA1c caused by high-dose insulin treatment. This experimentally induced neuropathy shares some features with TIND in humans and may be further explored in studies into the pathogenesis and treatment of TIND.