Reduction In HbA1c Levels Research Articles

Effectiveness and Safety of Oral Quadruple Combination Therapy in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis.

Achieving optimal glucose control is essential in the management of type 2 diabetes (T2D). This study aimed to evaluate the effectiveness and safety of oral quadruple combination therapy for the treatment of T2D. This meta-analysis reviewed original research on oral quadruple combination therapy for T2D, including both experimental and observational studies with a minimum duration of 12 weeks. The primary endpoint was the change in glycated hemoglobin (HbA1c) from baseline to follow-up. The secondary endpoint was the incidence rate of adverse events. Two investigators independently extracted data and assessed the risk of bias. Outcomes were pooled as the standardized mean difference (using Hedge's g) and the risk ratio for adverse events in random-effects meta-analyses. The meta-analysis included 17 studies. Oral quadruple combination therapy resulted in an additional mean reduction in HbA1c levels of 1.1% in patients who did not achieve glycemic control with oral triple combination therapy. Compared with switching to injectables, such as insulin or a glucagon-like peptide-1 receptor agonist-containing regimen, this therapy was non-inferior, even demonstrating a slightly superior glucose-lowering effect. Furthermore, it was determined to be safe, with an adverse event rate of 0.25, indicating no significant difference in safety compared with adding a placebo or switching to an injectable-containing regimen. Oral quadruple combination therapy is a valid option for patients with T2D who are unable to achieve glycemic targets with oral triple combination therapy, offering both effective glycemic control and a favorable safety profile.

Comparative Efficacy and Safety of Oral Semaglutide in Asians and Non-Asians Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

More than half of diabetes patients are Asians, and their tolerance to antidiabetic drugs may differ from that of non-Asians. Oral semaglutide has recently gained attention for its advantages in glycemic and body weight control. However, its effects across different ethnic groups remain unknown. All available databases of randomized controlled trials (RCTs) on oral semaglutide in patients with type 2 diabetes mellitus were included. These databases provided detailed patient information, including HbA1c levels, body weight, and adverse events (AEs and serious adverse events [SAEs]). Ten randomized controlled trials involving 7817 patients were included: six conducted in European and American populations and four in East Asian populations. In both the Asian and non-Asian patients' subgroups, oral semaglutide 3, 7, and 14mg was more effective in reducing HbA1c than placebo, and between-subgroups analysis showed that semaglutide 3, 7, and 14mg was more effective in reducing HbA1c in the Asian patients' subgroup than in the non-Asian patients' subgroup. There were no significant differences between subgroups in the number of patients achieving HbA1c < 5%. Non-Asian patients with type 2 diabetes showed significant weight reduction with 7mg and 14mg oral semaglutide, and Asian patients reduced body weight only with 14mg oral semaglutide. Between-subgroups analysis showed that 7mg oral semaglutide was more effective for weight reduction in non-Asian patients than in Asian patients. In the analysis of the efficacy of oral semaglutide at weeks 26 and 52 in Asian and non-Asian patients, in Asian patients, the hypoglycemic efficacy of oral semaglutide at 3-, 7-, and 14-mg doses at week 52 was significantly lower than that at week 26. In non-Asian patients, there was no significant difference in the reducing HbA1c efficacy of these doses of oral semaglutide at weeks 26 and 52. The weight-reduction efficacy of all doses of oral semaglutide did not change significantly with treatment duration in either Asian or non-Asian patients. Compared with sitagliptin, oral semaglutide was more effective in HbA1c reduction and weight reduction in both Asian and non-Asian patients. Subgroup analysis showed that compared with sitagliptin, Asian patients received oral semaglutide to achieve greater efficacy (HbA1c and weight reduction) than non-Asian patients. In the analysis of adverse events, oral semaglutide, as compared with placebo, was not associated with serious adverse events in either subgroup. The incidence of other (not including series) adverse events was significantly higher in non-Asian patients receiving 7mg and 14mg oral semaglutide. Oral semaglutide demonstrates superior efficacy in reducing HbA1c levels and a rapid onset of action in Asian patients. However, its efficacy appears to diminish with prolonged treatment in this population. Medium (7mg)-dose oral semaglutide was associated with greater weight reduction in non-Asian patients than in Asian patients, but this difference was eliminated with higher doses. Additionally, doses of 7mg or more of oral semaglutide are associated with a higher incidence of side effects in non-Asian patients.

Intermittent Use of Flash Glucose Monitoring Improves Glycemic Control in Chinese Older Patients with Type 2 Diabetes Mellitus.

To explore the efficacy and safety of intermittent use of flash glucose monitoring (FGM) for improving glycemic control in Chinese elderly patients with type 2 diabetes mellitus (T2DM). This is a prospective observational study involving patients with T2DM aged ≥60 years. The study period spans 12weeks, with participants wearing FGM at weeks 0, 5, and 10. Participants were divided into two subgroups based on HbA1c at enrollment: < 7.0% and ≥7.0%. The primary outcome of the study was HbA1c level. Secondary outcomes included time in range (3.9-10mmol/L) (TIR), time below range (<3.9mmol/L) (TBR), time above range (>10.0mmol/L) (TAR), and glycemic variability (GV). A total of 68 patients completed the 12-week FGM follow-up (age 67.9 ± 5.2 years; BMI 25.4 ± 3.3kg/m²). Overall findings revealed that compared to baseline, HbA1c decreased from 7.81 ± 1.25% to 7.44±1.10% after 12weeks of intermittent wearing of FGM (p <0.001). In the subgroup analysis with HbA1c ≥7.0%, the results showed a significant reduction in HbA1c of 0.51mmol/L after 12weeks (8.36 ± 0.95% vs 7.75 ± 0.97%, p < 0.001). And there was a significant reduction in TBR in the subgroup with HbA1c < 7% (p = 0.028). Multiple linear regression analysis showed that the baseline HbA1c (β = -0.529, P<0.001), duration of T2DM (β = 0.341, P = 0.001), and the frequency of sensor use (β = -0.269, P = 0.043) were associated with the reduction in HbA1c level. Intermittent use of FGM is associated with an improvement in glycemic outcomes and reduces the risk of hypoglycemia in Chinese elderly patients with T2DM.

Pharmacist-Led Digital Health Interventions for Patients with Diabetes: A Systematic Review.

Digital health interventions have emerged as a promising approach for patient care. The aim of this study was to conduct a systematic review of pharmacist-led digital health interventions for patients with diabetes. The PubMed database was used to select randomized controlled trials that assess the effectiveness of digital health interventions on clinical outcomes among patients with type 1 and 2 diabetes from January 2005 to May 2024. We included randomized controlled trial (RCT) studies on type 1 and 2 diabetes mellitus, analyzing the effects of all digital health interventions by pharmacists, including telephone-based intervention, web-based intervention, and mobile health application, as compared to usual care. The outcomes were a reduction in HbA1c, changes in medication adherence, and reduction of adverse effects. We used the PRISMA reporting standard to implement and report the results. A total of 19 studies were included. Among these, the included digital health interventions were telephone monitoring (n = 15), web-based intervention (n = 2), mobile health application (n = 1), and text-message reminder (n = 1). The findings showed variability: around half of the studies (n = 10, 52.63%) indicated that patients receiving digital health interventions had reduced HbA1c levels compared to those receiving usual care, while five studies (26.31%) found no difference between the intervention and usual care. Five studies (26.31%) showed that such interventions increased medication adherence, while two studies (10.53%) found no difference when compared to standard care. Effectiveness of the intervention is related to several factors, including practicability and patient engagement, frequency of the intervention, and the provision of personalized communication. Tailoring interventions to individual patient profiles and providing adequate support for enhancing practicability of these tools may improve their effectiveness. Further research assessing the cost-effectiveness of such intervention is necessary to inform healthcare policy.

Efficacy of imeglimin in patients with type 2 diabetes mellitus complicated by metabolic dysfunction-associated steatotic liver disease: A multicentre study.

This study aimed to evaluate the effectiveness of imeglimin in improving liver function and fibrosis in patients with type 2 diabetes (T2D) complicated by metabolic dysfunction-associated steatotic liver disease (MASLD). We conducted a multicentre study involving 80 patients with T2D and MASLD who were treated with or without imeglimin for 24 weeks. We assessed the changes in diabetes-related parameters, including HbA1c, fasting blood glucose, glycoalbumin and C-peptide index. Liver function was monitored using AST, ALT, γ-GTP and liver fibrosis indicators such as Fib-4 index and FibroScan-AST (FAST) score. Liver fat content and stiffness were measured using controlled attenuation parameter and vibration-controlled transient elastography, which were measured using FibroScan. Compared with the control group, imeglimin treatment led to a significant reduction in HbA1c levels, fasting blood glucose and liver-related parameters, including AST, ALT and γ-GTP. Additionally, the Fib-4 index and FAST score, which reflect liver fibrosis and inflammation, were significantly lower in the imeglimin group. Liver fat content and stiffness remained unchanged during the study period. Imeglimin efficaciously improved liver inflammation and fibrosis in patients with T2D and MASLD, with no significant changes in liver fat content or stiffness. These findings suggest that imeglimin is a promising therapeutic drug for the management of MASLD in the context of T2D, warranting further research on its long-term efficacy and mechanisms of action.

Effectiveness for adding or switching from other incretin-related drugs to oral semaglutide in type 2 diabetes.

This study aimed to evaluate and compare the effectiveness of oral semaglutide after adding to or switching from incretin-related drugs by assessing the changes in HbA1c and body weight (BW) in participants with type 2 diabetes in clinical settings. A total of 368 participants were divided into groups according to antidiabetic medications before oral semaglutide treatment; incretin-related drug-naïve (naïve), switching from dipeptidyl peptide-4 inhibitors (DPP-4i) or glucagon-like peptide-1 receptor agonist (GLP-1 RA) groups. Adjusted mean changes in HbA1c and BW at 6 months after oral semaglutide administration were compared among the three groups. Similar analyses were performed in the GLP-1 RAs group between GLP-1RAs before switching. Mean change of HbA1c in DPP-4i and GLP-1 RA groups was -0.67% (95% confidence interval [CI]: -0.79 to -0.54) and -0.13% (95% CI: -0.40 to 0.15), respectively, which were significantly smaller than incretin-related drug-naïve group; -0.85% (95% CI: -1.08 to -0.62). Mean change in BW between the naïve and DPP-4i groups had no differences; however, these changes were lower in the GLP-1 RA group than in the naïve group. Mean change in HbA1c between pretreatment with GLP-1 RAs had no differences; however, the mean change in BW in the dulaglutide group was significantly higher than that in the injectable semaglutide group. Oral semaglutide reduced HbA1c levels and BW after adding or switching from other incretin-related drugs in Japanese participants with type 2 diabetes.

Effect of introduction of intermittently scanned continuous glucose monitoring on glycaemic control in individuals living with type 2 diabetes mellitus treated with non-insulin therapies-A randomised controlled trial.

This pilot randomised controlled trial aimed to evaluate the effect of introducing isCGM on glycaemic control and diabetes distress in individuals with T2DM receiving non-insulin therapies. Forty adults with T2DM were randomised to either receive FreeStyle Libre 2 (Libre 2), an isCGM system, or FreeStyle Libre Pro iQ (Libre Pro) also known as 'blinded' CGM. Participants were followed for 12 weeks. The primary outcome was a fall in haemoglobin A1c (HbA1c) of ≥5.5 mmol/mol. Diabetes distress was assessed using the two-item diabetes distress scale (DDS2). The median age was 59.5 years; 57.5% were male. Of the Libre 2 users, 53% achieved a ≥5.5 mmol/mol reduction in HbA1c compared to 35% in the Libre pro group (p = 0.34). Compared to Libre Pro, the use of Libre 2 was associated with an improved time in range at 12 weeks of 18 percentage points (confidence interval 2-35, p = 0.028). Participants in the Libre 2 group exhibited a non-significant reduction in HbA1c levels of 8 mmol/mol compared to the Libre Pro group after 12 weeks. However, no significant differences were observed in other CGM metrics or diabetes distress between the study groups. The use of isCGM in individuals living with T2DM on non-insulin therapy showed promise in improving glycaemic control, as evidenced by increased TIR, albeit without a significant reduction in HbA1c or impact on diabetes distress, suggesting this could be potentially beneficial in individuals with T2DM.

A COMPARATIVE STUDY OF TENELIGLIPTIN VERSUS HYDROXYCHLOROQUINE AS ADD ON THERAPY IN UNCONTROLLED TYPE-II DIABETES MELLITUS PATIENTS

Objectives: This study aimed to compare the efficacy and safety of teneligliptin versus hydroxychloroquine (HCQ) as add-on therapy in uncontrolled T2DM patients. To measure the safety and efficacy of Teneligliptin and Hydroxychloroquine as add on therapy in uncontrolled type-2 diabetes mellitus patients. To compare the safety and efficacy of Teneligliptin and Hydroxychloroquine during the study. To assess the Glycaemic control in patients of Type-2 diabetes mellitus before treatment and after treatment. Methods: This randomized, Observational and Prospective study enrolled 124 uncontrolled T2DM patients who were inadequately controlled on Metformin and Glimepiride therapy. Patients were randomly assigned to receive either teneligliptin (20mg/day) or HCQ (400mg/d ay) as add-on therapy for week 4,12 and 24 weeks. The primary outcome was the change in HbA1c from baseline to week 24. Results: Both Teneligliptin and HCQ significantly reduced HbA1c levels from baseline, with a greater reduction observed in the Teneligliptin group (p &lt; 0.001). Additionally, the Teneligliptin group demonstrated improved fasting blood sugar (FBS) and postprandial glucose (PPG) levels in comparison to Hydroxychloroquine. Conclusion: This study suggests that Teneligliptin is a more effective and tolerable add-on therapy compared to Hydroxychloroquine in uncontrolled T2DM patients, highlighting its potential as a valuable treatment option for improving glycaemic control.

Improved glycemic and weight control with Dulaglutide addition in SGLT2 inhibitor treated obese type 2 diabetic patients at high cardiovascular risk in a real-world setting. The AWARE -2 study

We evaluated the effects on glycemic control and body weight of a GLP1-RA in obese type 2 diabetic patients treated with SGLT2-inhibitors and other hypoglycemic agents and/or insulin, in a real-world setting. A cohort of 583 type 2 diabetic outpatients treated with a SGLT2 inhibitor and/or other anti-diabetic medications were examined. Because patients had suboptimal glycemic control, the GLP1-RA Dulaglutide was added to ongoing medications. At 6 months, 334 patients had a follow-up visit. Patients were classified in terms of cardiovascular risk (CVR) employing the ESC-EASD 2019 criteria, with the AWARE app. The study's primary endpoints were changes in: 1) HbA1c level, 2) BMI, and 3) body weight after six months of treatment. Secondary endpoints were evaluation of Dulaglutide addition in type 2 diabetic patients: 1) with more or less than ten years of T2DM; 2) more or less than 75 years of age and in different subgroups of CVR. In the 334 patients which had a 6 months follow-up visit, age was 65,9+9,8; 33.5 % (112) were females and 66.5 % (222) were males. After six months of Dulaglutide treatment, we found a significant reduction in HbA1c levels (8.0+10.5 mmol/mol; p<0.0001) and in body mass index (1.1+1.1 kg/m2; p<0.0001). Efficacy of Dulaglutide was not affected by different CVD risk categories, age and T2DM duration. This real world study provides evidence for significant reductions in HbA1c level, body mass index and body weight in obese type 2 diabetic patients who received add-on treatment with the weekly GLP-1RA, Dulaglutide.

Handgrip strength, cardiometabolic risk and body composition in youth with type 1 diabetes: the Diactive-1 Cohort Study

ObjectiveThis study aimed to explore the association between handgrip strength, cardiometabolic risk (CMR) and body composition in youth with type 1 diabetes.MethodsFor this prospective cohort study, muscular fitness was assessed...

The Effect of a Health Education Program on Knowledge, Medication Adherence, and Glycosylated Hemoglobin in Rural Patients with Type 2 Diabetes

Background: Improving medication adherence plays a crucial role in preventing adverse complications of type 2 diabetes. Objectives: This study aimed to determine the effect of a health education program on knowledge, medication adherence, and HbA1c in rural patients with type 2 diabetes. Methods: This experimental study was conducted in Ilam County, Iran. Participants were selected via multistage cluster sampling and randomly assigned to either the intervention group (n=43) or the control group (n=42). The intervention group underwent a one-month educational program based on self-regulation theory, consisting of 12 sessions, while the control group received no educational intervention. Data were collected at baseline, three months, and six months using a diabetes knowledge test (DKT), the Iranian version of the Morisky Medication Adherence Scale-8 (IVMMAS-8), and laboratory measurements of HbA1c. Statistical analysis was performed using SPSS version 16, employing chi-square tests, independent sample t-tests, repeated-measures ANOVA, and Bonferroni correction at a significance level of 0.05. Results: After 3 and 6 months, the intervention group showed significant improvements in diabetes knowledge and medication adherence and a significant reduction in HbA1c levels compared to the control group (p&lt;0.001). No significant changes were observed in the control group over time (p&gt;0.05). Conclusion: This study demonstrated that health education based on self-regulation theory can effectively increase knowledge, improve treatment adherence, and decrease HbA1c levels in rural patients with type 2 diabetes.

The Effect Combining Snakehead Fish Extract, Meniran, and Temulawak on Glycemic Status and Pancreatic Histopathology in High-Fat Diet Diabetic Rats

Diabetes mellitus is a metabolic disorder characterized by hyperglycemia, frequently associated with obesity, dyslipidemia, hypertension, and cardiovascular complications, particularly in type 2 diabetes mellitus (DM). In Indonesia, traditional medicine is often favored for its safety and cost-effectiveness compared to synthetic drugs. This study involved 25 male Wistar rats, which were divided into five groups: a control group, an alloxan and high-fat diet group, a pioglitazone group, a plant extract group, and a combination group. Obesity was induced over 27 days through a high-fat diet, followed by the administration of alloxan to elevate blood glucose levels. Glucose measurements were taken at specified intervals, with HbA1c assessed on day 26, and pancreatic histopathology was analyzed post-study. The Kruskal-Wallis test revealed significant differences in weight gain (p = 0.016) and blood glucose levels (p = 0.003) among the groups. Although no significant difference was observed in blood glucose reduction (p = 0.05), the combination group exhibited the most substantial decrease. One-way ANOVA results demonstrated that the combination of the extract and pioglitazone significantly reduced HbA1c levels (p &lt; 0.001), with the second group showing the highest levels and the fourth group displaying the most pronounced reduction. Histopathological analysis indicated damage to the islets of Langerhans in both the pioglitazone and extract groups. The combination of snakehead fish extract, meniran, temulawak, and pioglitazone effectively lowers blood glucose and HbA1c levels; however, it does not appear to ameliorate islet damage, likely due to oxidative stress resulting from the treatments

A Nutritional Strategy Based on Multiple Components for Glycemic Control in Type 2 Diabetes: A Multicenter Randomized Controlled Clinical Trial.

The optimal dietary approach for managing glycemic and metabolic control in type 2 diabetes (T2D) is still uncertain, though it should be tailored for clinical settings. Therefore, we sought to assess the impact of a multicomponent nutritional strategy on glycemic control in T2D patients within a public health system. NUGLIC was an open-label, parallel-group, superiority, multicenter randomized controlled trial. Participants aged 30 and older with poorly controlled T2D were randomly assigned to either (1) a personalized dietary prescription (control group, n = 185) or (2) a strategy involving targeted nutritional advising, mindfulness techniques, and short message services (NUGLIC [intervention] group, n = 186). The primary outcomes were glycated hemoglobin (HbA1c, %) measured after 24 weeks and glycemic control, defined as having an HbA1c > 7% at baseline and achieving ≤7% after follow-up, or having HbA1c ≤ 7% at baseline and reducing the use of glucose-lowering medications post-follow-up. The secondary outcomes included cardiometabolic features, self-care practices, diet quality, and quality of life. A total of 371 participants were included in an intention-to-treat analysis for the primary outcomes. At six months, both groups exhibited a reduction in HbA1c levels compared to the baseline (NUGLIC group: -0.6% [95% confidence interval (CI) -0.9; -0.3], p < 0.001; control group: -0.5% [95% CI -0.7; -0.3], p < 0.001). However, no significant differences were observed between the groups in terms of HbA1c after follow-up (intervention group: 8.1%; control group: 8.3%; difference: -0.2% [95% CI -0.5; 0.1], p = 0.30) or glycemic control (NUGLIC group: 19.9%; control group: 18.9%; odds ratio 0.96 [95% CI 0.56; 1.67], p = 0.89). While the control group showed an improvement in overall diet quality, no significant differences emerged between the groups by the end of this study (p = 0.13). There were also no significant differences in other secondary outcomes nor in the use of glucose-lowering medications and adverse events after follow-up. The multicomponent nutritional strategy did not demonstrate superiority over personalized dietary prescriptions in achieving glycemic control for participants with poorly managed T2D. In this sense, both nutritional interventions could be used in clinical practice to improve HbA1c levels, considering the profile and preferences of individuals.

The Impact of The Alphabet Strategy for Diabetes Mellitus: A Literature Review

Background: The number of people with diabetes continues to increase, and the inability to control blood glucose increases the risk of complications, morbidity, and mortality. Diabetes mellitus requires lifelong self-care management to keep blood glucose levels within normal limits and reduce the risk of complications. One effective self-care management strategy is the alphabet strategy, which is proven to improve glycemic control. Objective: This study aims to evaluate the effectiveness of the alphabet strategy in improving outcomes for individuals with diabetes. Methods: This systematic literature review was conducted in accordance with PRISMA guidelines. We searched four major databases ScienceDirect, PubMed, Springer, and Wiley using keywords defined by the PICO framework. Results: The findings indicated a significant reduction in HbA1c levels, a decrease in systolic blood pressure, and improved medication adherence as a result of the alphabet strategy implementation. Conclusion: The alphabet strategy is an effective, adaptable, and cost-efficient intervention for diabetes management, offering significant improvements in clinical outcomes and feasibility across various healthcare settings.

Systematic Review: The Impact of Traditional Medicine Combined with Standard Diabetes Management versus Standard Management Alone on HbA1c Levels in Type 2 Diabetic Patients

The management of Type 2 diabetes requires a multifaceted approach to achieve optimal glycemic control. This systematic review examines the impact of combining traditional medicine practices, such as herbal remedies, dietary supplements, traditional Chinese exercises, and plant-based diets, with standard diabetes management on HbA1c levels in adults with Type 2 diabetes. A total of 10 studies, including randomized controlled trials, systematic reviews, and meta-analyses, were analyzed. The findings indicate that most traditional medicine interventions, when combined with standard care, resulted in significant reductions in HbA1c levels, suggesting enhanced glycemic control. The most effective interventions included the Mediterranean diet, traditional Chinese exercises, and specific herbal remedies like cinnamon and ginseng. However, one study utilizing the chronic care model showed no significant improvement. This review highlights the potential of integrating traditional medicine practices into conventional diabetes management protocols for improved outcomes. Further large-scale, long-term studies are recommended to validate these findings and explore the mechanisms underlying the observed benefits.

Impact of Opuntia ficus-indica Juice and Empagliflozin on Glycemic Control in Rats.

Diabetes mellitus (DM) is a major global health concern characterized by high blood glucose levels. This study investigates the effects of Opuntia ficus-indica (cactus) juice and empagliflozin, both alone and in combination, on glycated hemoglobin (HbA1c) levels in healthy and streptozotocin-induced diabetic rats. Eighty Wistar albino male rats were divided into eight groups, with four groups being diabetic. Treatment options included cactus juice, empagliflozin, or both. HbA1c levels were measured at baseline and 100 days later using ELISA. In diabetic and non-diabetic rats treated with cactus juice or empagliflozin, HbA1c levels were significantly reduced, but diabetic rats had significantly lower HbA1c values than non-diabetic rats. The combined treatment provided no additional benefits over individual therapies. These findings indicate that cactus juice and empagliflozin effectively lower HbA1c levels, making their use a promising complementary approach to diabetes management. However, the combined treatment of Opuntia ficus-indica juice and empagliflozin did not yield additional reductions in HbA1c levels compared to individual treatments, with no significant synergistic effects observed throughout the study period. More research is needed to better understand the clinical applications and mechanisms in humans.

Effects of concurrent aerobic and strength training in patients with type 2 diabetes: Bayesian pairwise and dose-response meta-analysis

This study aimed to investigate the effects of concurrent aerobic and strength training (CT) in patients with type 2 diabetes and determine the most effective dose of CT. From the...

Comparing the Efficacy and Long-Term Outcomes of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Dipeptidyl Peptidase-4 (DPP-4) Inhibitors, Metformin, and Insulin in the Management of Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia, insulin resistance, and decreased insulin secretion. With its rising global prevalence, effective management strategies are critical to reducing morbidity and mortality. This systematic review compares the efficacy, safety, and long-term outcomes of four major pharmacological treatments for T2DM: sodium-glucose cotransporter-2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4)inhibitors, metformin, and insulin. We focused on randomized controlled trials (RCTs) published within the last five years (2019-2024) to provide an up-to-date assessment of glycemic control, cardiovascular and renal benefits, weight effects, and the risk of hypoglycemia. The review highlights that while all four medication classes effectively reduce HbA1c levels, SGLT2 inhibitors stand out for their additional cardiovascular and renal benefits, including significant reductions in major adverse cardiovascular events and chronic kidney disease progression. Metformin remains a cornerstone first-line therapy due to its safety, efficacy, and affordability. DPP-4 inhibitors are a weight-neutral, well-tolerated option, although their efficacy may diminish over time. Insulin, while the most potent glucose-lowering agent, carries a higher risk of hypoglycemia and weight gain. Our findings emphasize the importance of personalized, patient-centered approaches that account for the distinct therapeutic profiles of these treatments. Future research should prioritize head-to-head comparisons and optimal therapy sequencing to refine treatment guidelines for diverse patient populations.

SGLT2i and GLP1RA effects in patients followed in a hospital diabetology consultation

ABSTRACT Background We aimed to investigate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) in patients with type 2 diabetes mellitus (T2DM) in clinical practice. Research design and methods A total of 340 patients were included. Data on age, gender, antidiabetic medications, and bioanalytical parameters were collected at baseline and one year later. Were analyzed estimated glomerular filtration rate (eGFR), blood sodium and potassium levels, blood pressure, weight, cardiovascular risk, and glycated hemoglobin (HbA1c). Results Patients treated with SGLT2i exhibited a significant improvement in eGFR at the endpoint compared to baseline (p = 0.006). Both treatment groups experienced reductions in systolic blood pressure at the endpoint; especially patients treated with SGLT2i (p = 0.0002). GLP1RA treatment resulted in a statistically significant weight reduction from baseline to endpoint (p < 0.0001), with a higher percentage of patients achieving ≥ 5% weight loss compared to the non-GLP1RA group (33.6% vs. 19.8%). Both SGLT2i and GLP1RA treatments significantly reduced cardiovascular risk scores (p = 0.004 and p = 0.002, respectively). Additionally, both treatments were associated with a significant reduction in HbA1c levels at the endpoint (p = 0.010 and p = 0.002, respectively). Conclusions Our findings suggest that SGLT2i and GLP1RA offer beneficial effects in patients with T2DM.

Improving Diabetes Education and Metabolic Control in Children Using Social Robots: A Randomized Trial

Robot engagement in healthcare has the potential to alleviate medical personnel workload while improving efficiency in managing various health conditions. This study evaluates the impact of robot-assisted education on knowledge acquisition and metabolic control in children with Type 1 Diabetes Mellitus (T1DM) compared to traditional education methods. A randomized controlled trial was conducted at the pediatric diabetes clinic of the University of Tabuk Medical Center, Saudi Arabia. Thirty children aged 5–15 years with T1DM were randomly divided into two groups: the robot education (intervention) group and the control education group. Both groups participated in six weekly one-hour educational sessions, with the intervention group interacting with a Pepper robot assistant and the control group receiving education from a qualified diabetes educator nurse. Knowledge was assessed using a 12-item questionnaire before and after the intervention, while metabolic control was evaluated through weekly mean home blood glucose measurements and HbA1c levels before and three months post intervention. The intervention group demonstrated a significantly greater improvement in knowledge scores compared to the control group (p &lt; 0.05). Weekly mean blood glucose levels were consistently lower in the intervention group throughout the study period (p &lt; 0.05 for all samples). Both groups showed a reduction in HbA1c levels after three months, with the intervention group exhibiting a greater mean decrease. The engagement of the Pepper robot in T1DM education for children resulted in improved knowledge acquisition and better metabolic control compared to traditional education methods. This approach may establish a foundation for “learning by interacting with robots” in long-term diabetes management. Further research with larger sample sizes and longer follow-up periods is warranted to confirm these findings and explore the long-term benefits of robot-assisted education in pediatric diabetes care.