Risk Factors In Diabetic Patients Research Articles

Assessment of Selected Serum Electrolyte and Associated Risk Factors in Diabetic Patients.

PurposeThe objective of this study was to assess selected serum electrolytes imbalance and associated factors in diabetic patients attending their follow up appointments in Jimma University Medical Center (JUMC) from February 1 to April 1, 2019.Patients and methodsA cross sectional study design was used to assess the selected serum electrolytes in diabetic patients attending their follow up appointments at Jimma University Medical Center (JUMC) chronic illness clinic. A convenience sampling technique was used to include 279 diabetic patients in the study and an interviewer based questionnaire was used to include all necessary data from each diabetic patient. Five milliliters of blood were collected from each subject and processed and analyzed for blood glucose and serum electrolyte determination by ABX Pentra400 and Humalyte plus5 ion-selective electrode (ISE) system clinical chemistry analyzers. Pearson's correlation coefficient model and multivariate logistic regression were used respectively to assess the correlation and significant association between abnormal serum electrolytes and independent variables.ResultsA high prevalence of one or more serum electrolyte abnormalities was determined in diabetic patients. The overall prevalence was 42.0% (n=116/276) in which hyponatremia was the highest followed by hypochloremia and hypercalcemia, 40.6%, 14.9% and 10.9% respectively. Age, type of medication, and high body mass index (BMI) had strong positive correlations with abnormal serum concentration levels of sodium (r=0.611, P=0.731), potassium (r=0.752, P=0.812) and chloride (r=0.645, P=0.459). Being employed (AOR: 3.933, 95% C.I: 1.057–14.637, P value: 0.041), treated with mixed medications (AOR: 2.9, 95% C.I: 1.292–6.441, P value: 0.010) and being unable to control blood glucose level or being hyperglycemic (AOR: 3.2, 95% C.I: 2.179–5.721, P value: 0.000) were statistically identified as risk factors for serum electrolyte abnormalities in diabetic patients.ConclusionThe serum electrolyte concentration level was highly abnormal in diabetic patients. The prevalence of abnormal concentration was more common in diabetic patients with advanced age, and some variables had strong positive correlation with abnormal serum electrolyte level in diabetic patients.

Gender-Specific Association of Oxidative Stress with Cardiovascular Risk Factors in Diabetic Patients of Central Punjab, Pakistan

Gender-Specific Association of Oxidative Stress with Cardiovascular Risk Factors in Diabetic Patients of Central Punjab, Pakistan

Coste del tratamiento farmacológico de los factores de riesgo cardiovascular en población diabética anciana según género (Estudio ESCADIANE)

AimsTo study the cost of pharmacological treatment used for the control of cardiovascular risk factors in patients with type 2 diabetes mellitus (DM2)> 65 years and the prevalence of cardiovascular complications according to gender. DesignCross-sectional, observational, multicentric study. LocationNational study. ParticipantsPatients with diabetes mellitus 2> 65 years. Main measurementsprevalence of cardiovascular risk factors and their cost in patients with diabetes mellitus 2. ResultsWe studied 947 patients (53% females) with a mean age of 76.2±7.3 years. 14% had suffered acute myocardial infarction (17.8% men vs. 10.7% women, p=.001), 11.9% had stroke (13.7% men vs. 10.5% women; p=ns), 11.3% heart failure (10.9% men vs. 11.7% women, p=ns) and 9% peripheral arterial disease (12.1% men vs. 6.3% women; p=.001). Oral antidiabetic drugs accounted for the highest cost (414.76±210.18 € patient / year), mainly due to DPP-4 inhibitors (49.9% of the cost of antidiabetics), followed by basal insulin (29.95%) and without significant differences between gender. The annual expenditure of antihypertensive drugs per patient/year was higher in women than in men (86.80±32.84 € vs. 78.24 €±26.86, p=0.0001). The antiaggregants significantly lower in women (20.87±7.25 € vs. € 30.21±13.68, p=0.0001). ConclusionsAntidiabetic drugs represented the highest cost in controlling cardiovascular risk factors in diabetic patients> 65 years of age, followed by hypotensives, hypolipements and antiaggregants. Women had higher spending on anti-hypertensives and men on antiaggregants.The most frequent macrovascular complications in men were AMI, arrhythmias and stroke. There were only gender differences for infarction.

Plant Protein Intake Is Not Associated with Cardiovascular Disease Risk Factors in Diabetic Patients with Chronic Kidney Disease (P08-055-19)

ObjectivesA higher percentage of protein consumed from plants may have cardiovascular benefits and be associated with lower mortality in chronic kidney disease (CKD) patients. The purpose of this study was to examine the association of self-reported dietary protein intake with cardiovascular disease (CVD) risk factors in patients with type 2 diabetes (T2D) and CKD. MethodsBaseline 3-day food records were obtained from 202 participants of an ongoing lifestyle intervention study, and analyzed using Nutrition Data System for Research (2014). Participants were categorized into tertiles based on total protein intake (<66.9 g, 66.9–92.4 g, > 92.4 g) and percent of total protein coming from plant sources (<27.9%, 27.9–37.8%, >37.8%). CVD risk factors included estimated glomerular filtration rate (eGFR), pulse wave velocity (PWV), fasting lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides [TG]), and hemoglobin A1c [HbA1c]). Analyses of covariance examined mean differences in CVD risk factors among the tertiles, controlling for age and total energy intake. ResultsThe participants were 57% male, 89% non-Hispanic, 69% white, and 66 ± 9 years of age with a mean body mass index of 33.6 ± 5 kg/m2. Prior myocardial infarction was reported by 25(12.6%) of participants. Average daily protein intake was 83.3 ± 29.3 g (0.9 ± 0.3 g/kg body weight), with the average % of protein consumed from plant sources 34 ± 13%. There were no statistically significant differences between the total protein intake tertiles for the CVD risk factors (eGFR [P = .36], PWV [P = .86], total cholesterol [P = .09], LDL-cholesterol [P = .26], HDL-cholesterol [P = .88], TG [P = .88], HbA1c [P = .82]. Additionally, there were no statistically significant differences between the % of total protein intake from plant sources tertiles for the CVD risk factors (eGFR [P = .32], PWV [P = .92], total cholesterol [P = .29], LDL-cholesterol [P = .10], HDL-cholesterol [P = .57], TG [P = .13], HbA1c [P = .93]. ConclusionsContrary to expectations, CVD risk factors did not differ among tertiles for total protein intake or % of total protein from plant sources. These findings suggest that, at baseline, dietary protein was not associated with CVD risk factors in patients with T2D and CKD. Funding SourcesNational Institutes of Health (NIDDK, NINR).

TGR5 activation ameliorates hyperglycemia-induced cardiac hypertrophy in H9c2 cells

Left ventricular hypertrophy is an independent risk factor in diabetic patients. TGR5 is shown to express in hearts, but its functional role in diabetes-induced cardiac hypertrophy remained unclear. The current study investigated the role of TGR5 on high glucose-induced hypertrophy of H9C2 cells. After incubation with a high level of glucose, H9C2 cells showed hypertrophic responses. Activation of TGR5 by lithocholic acid (LCA) ameliorated cell hypertrophy and enhanced SERCA2a and phosphorylated phospholamban (PLN) expression in H9C2 cells. Triamterene inhibited these effects at an effective dose to block TGR5. However, LCA failed to modify the free radical elevation induced by high-glucose in the H9c2 cells. Moreover, PKA inhibitors, but not an Epac blocker, markedly improved hyperglycemia-induced hypertrophy and attenuated the increased SERCA2a expression by LCA; it also attenuated the phosphorylated PLN and SERCA2a protein expression levels in high glucose-treated H9C2 cells. In conclusion, TGR5 activation stimulated protein kinase A (PKA) to enhance PLN phosphorylation, which activated SERCA2a to remove Ca2+ from cytosol to sarcoplasmic reticulum in addition to the reduction of calcineurin/NFAT pathway signaling to ameliorate the hyperglycemia-induced cardiac hypertrophy shown in cardiomyocytes. TGR5 may service as a new target in the control of diabetic cardiomyopathy.

Sugary beverages are associated with cardiovascular risk factors in diabetic patients.

Sugar-sweetened beverages (SSBs) containing high amount of added sugars have increased over the last decades. Due to increased risk of cardiovascular events in type 2 diabetes mellitus (T2DM) patients, we designed a study to assess the association between SSBs and metabolic syndrome, a collection of cardiovascular risk factors, in these patients. A cross-sectional study was performed on T2DM adults (N = 157). Participants had no serious disease or insulin treatment. SSBs records were obtained from a validated food frequency questionnaire. Metabolic syndrome status was extracted from biochemical and anthropometric measurements. Subjects risk factors were compared based on their usual SSBs consumption. About half of participants consumed at least one serving of SSBs (Mean intake: 145.6mL/d) on a weekly basis. Men and women had a similar SSBs pattern. Demographic and anthropometric characteristics were identical in both groups. Higher SSBs intake (≥ 0.5 vs <0.5 serving/ week) was positively associated with hypertension (OR: 3.48, 95% CI: 1.31, 9.26) and obesity (OR: 4.61, 95% CI: 1.31, 16.25). After adjustment for confounders, a higher risk of the metabolic syndrome was observed in those with higher SSBs intake (OR: 4.23, 95% CI: 1.42, 12.62). Drinking SSBs, even in low amounts, could potentially elevate the risk of cardiovascular risk factors in diabetic patients. Reduction of sugary drinks would be an urgent recommendation.

Three Months Monitored Metabolic Fitness Modulates Cardiovascular Risk Factors in Diabetic Patients.

Cardiovascular diseases represent the leading cause of death and moderate physical exercise is associated with a reduction in cardiovascular risk. The aim of the study was to evaluate the correlation between the amount of exercise recorded daily by a wearable gravitometer for 3 months and selected biochemical and clinical parameters. Nineteen sedentary type 2 diabetics were recruited and distributed into three homogenous groups, low, medium, and high exercise, according to the level of physical exercise monitored and expressed as MOVEs. Data showed an inverse correlation between MOVEs and oxidative stress indexes and a significant improvement in paraoxonase-1 activities and endothelial functionality. Decrease of visceral/total adipose tissue ratio, systolic blood pressure and a down-regulation of the inflammatory microRNA-146a in high exercise group were observed. Finally, a decrease of glycosylated hemoglobin and an up-regulation of the angiogenic microRNA-130a in medium exercise one was obtained. In this study, precise daily monitoring permitted to underline the importance of the amount of physical activity to counteract some cardiovascular risk factors persisting in diabetes. Finally, it identifies new microRNA biomarkers for future investigation on the same topic.

Incidence and Risk Factors of Peripherally Inserted Central Catheter-related Complications in Patients with Diabetes: A Retrospective Study

Background: Peripherally inserted central catheters (PICCs) related complications are common in catheterization patients. Many patients with PICC catheterization have diabetes mellitus. The data of incidence and risk factors in diabetic patients are scarce. Methods: A retrospective, multicenter study was performed on diabetic patients with PICC insertion from May 2017 to June 2018. A mobile App was used to collect patients and insertion information. We used univariable and multivariable analysis to examine the risk factors of PICC-related complications. Results: A total of 103 diabetic patients were included with 13 (12.6%) patients developed complications. In univariable analysis, marriage (P=0.002), prior surgery (P<0.001) were associated with complications. Following logistic regression analysis, marriage (OR 0.13, 95 CI% 0.03-0.58, P=0.007) and prior surgery (OR 2.30, 95% CI 2.33-42.68, P=0.002) remained to be independent risk factors of complications. Conclusion: For diabetic patients, paying more attention to these who unmarried and have surgery history may reduce the risk of adverse outcome.

Potential risk factors and outcomes of infection with multidrug resistance among diabetic patients having ulcers: 7 years study

Diabetes Mellitus is characterized as a hyperglycemic condition, which results due to alteration in the secretion of insulin or action of insulin. The development and spread of microorganisms is known as a key health concern, and such cases are growing drastically in hospitals and communities. Therefore, the study aims to determine the potential risk factors and infection outcomes among diabetic patients with multi drug resistance, who are suffering from foot ulcerations. A prospective cohort analysis was carried out among 192 diabetic patients admitted in the Rajiv Gandhi Centre for Diabetes and Endocrinology of Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, India. The patients having ulcer or ulcers in their foot during the period December 2008–June 2015 were included in the study. The results indicated the rate of resistance to CS and PC, which was 56.7% and 51.9%. The most common isolates included Escherichia coli (25.5%), Staphylococcus aureus (22.6%), and Klebsiella sp (5.4%). A total of 121 isolates from 278 were associated with the MDR. Furthermore, anaerobic isolates were also included in the study which included Peptostreptococcus spp, Propionibacterium spp, Clostridium perfringens, Eggerthella lenta, and Bacteroides ureolyticus. Ulcer was found among majority of patients with the duration of 1 month; whereas, the ulcer size was also the major risk factor for diabetic patients. Therefore, it is concluded that there is a major need for surveillance of resistant bacteria to reduce the risk of major complications.

Characteristics of diabetic foot disease and risk factors in Benghazi, Libya

Introduction: Diabetic foot ulcer and amputation are associated with an increased incidence of morbidity and mortality. Diabetic foot ulcer can be prevented by screening for risk factors and proper interventions. Objectives: We aimed to determine the risk of diabetic foot ulcer and amputation among patients with type 2 diabetes at Benghazi Medical Center diabetic clinic. Patients and Methods: A cross-sectional study of diabetic foot status and risk factors in diabetic patients attending a specialist diabetes clinic in Benghazi, Libya. Results: Eighty-seven (84.5%) patients wear inappropriate shoes, 37 (35.9%) had Tinea pedis, 26 (25.2%) had foot deformity, 13 (12.6%) patients had bilateral hallux valgus deformity, 8 (7.8%) patients had clawing of feet, 2 (1.9%) patients had Charcot joint, and one patient (0.97%) had amputated toes. Dorsalis pedis and posterior tibial arteries pulsations were not palpable in six (5.8%) patients, there was a loss of protective sensation among 20 (19.4%) patients, vibration sense was absent in 15 (14.6%) patients, and joint position sense was lost in five (4.9%) patients. According to Scottish Intercollegiate Guideline Network system, 59 (57.3%) patients were in the low-risk category, 18 (17.5%) were in the moderate-risk, 22 (21.4%) were in the high-risk, and 4 (3.9%) were in the active disease categories. Conclusions: We conclude that the prevalence of diabetic foot risk factors is high among the studied group.

Risk of latent tuberculosis infection among diabetic patients in Azadi Teaching Hospital, Duhok province: a case control study

Diabetes can be linked with impaired host immunity that subsequently increases the rate of various infections including tuberculosis (TB), particularly in developing countries where TB is endemic. The objectives of this case control study were to determine the prevalence and the risk of LTBI among diabetic patients. It is a prospective case control study conducted in Azadi Teaching Hospital from September 2017 until May 2018. The diabetic patients included in this study were randomly selected. The diagnosis of diabetes mellitus (DM) was made according to the American Diabetes Association (ADA). Diabetes mellitus patients and the control participants were offered a voluntary tuberculin skin test (TST). The TST ≥10 mm was considered positive. The results were analyzed by entering the data in SPSS (statistical package for the social sciences, version 16; SPSS Inc., Chicago, Illinois, USA). Two hundred DM patients and 208 control individuals participated in this study. Collectively, 28 patients had positive TST results. Based on the sputum smear microscopy and CXR, none of these patients showed active TB disease. The differences between the DM patients and the control group had no statistical significance apart from previous hospitalization. The prevalence of LTBI was 23.53% in the diabetic group, whereas, it was 9.62% in the control group. The frequency of LTBI in diabetic patients was significantly higher than the control group. When the diabetic group was compared with the control group in terms of diabetic control and the duration of diabetes disease, there was a statistically significant association of diabetes duration ≥ 10 years and TST positivity. In conclusion, the previous hospitalization was a significant risk factor for diabetic patients to acquire TB bacilli. Latent TB infection was more common in diabetics than non diabetics and there was an increased likelihood of having LTBI with the duration of diabetes ≥ 10 years. To avoid the threatening of TB control program, prophylactic treatment of LTBI in diabetic patients is paramount.Asian J. Med. Biol. Res. June 2018, 4(2): 227-232

A comparative analysis of fructosamine with other risk factors for kidney dysfunction in diabetic patients with or without chronic kidney disease

BackgroundHyperglycemia is the driving force for the development of diabetic nephropathy leading to the end stage renal disease. It is well known that in hyperglycaemic condition, serum proteins become glycated through non-enzymatic glycation. With the other risk factors, serum fructosamine may be an important risk factor for kidney impairment. To assess coexistence of frequently documented risk factors of kidney dysfunction with serum fructosamine in diabetic patients with chronic kidney disease (CKD). MethodsIn this study, total 150 individuals, as control, type2 diabetic patients without complication and with CKD were included. Blood samples were collected from all the samples to estimate blood glucose, HbA1c, serum creatinine, fructosamine levels and lipid profile. Statistical analysis i.e. regression and correlation between serum fructosamine and other documented risk factors for diabetic CKD has been done. P < 0.001 was considered significant. ResultsSerum fructosamine, HbA1c, creatinine levels, cholesterol and LDL were increased significantly (P < 0.001) in diabetic patients with CKD compared to without complications. Systolic and diastolic blood pressure and BMI were also significantly higher in diabetic patients compared to control. Serum creatinine, total cholesterol and LDL showed a significant positive correlation but HDL showed a negative correlation with fructosamine in CKD diabetic patients. No significant correlation was found with any risk factors in diabetic patients without complications expect HbA1c. ConclusionIt is concluded that elevated serum fructosamine level is strongly associated with kidney dysfunction in diabetic patients. As there is a significant link between serum fructosamine and other risk factors for CKD diabetic patients.

Continuous Remote Care Model Utilizing Nutritional Ketosis Improves Type 2 Diabetes Risk Factors in Patients with Prediabetes

Prediabetes (preT2D) is a major U.S. public health concern, as over 84 million adults are at greater risk of cardiovascular disease and progression to type 2 diabetes (T2D). Abnormal glucose, BMI, blood pressure, and blood lipids are risk factors for progression to T2D. The purpose of this single-arm prospective longitudinal investigation was to assess change in risk factors after one year of treatment with a continuous remote care model utilizing nutritional ketosis, behavior change, and support from a health coach, medical provider, and peers provided via an online clinic. Patients with preT2D enrolled (n=116); at 1 year, 95 participants (82%) remained active. Results are reported for participants with measurements completed at 1 year and baseline; n varied across measures (range: 77-95). Changes from baseline to 1 year included: weight -13.1±9.5 kg (from 110.6±23.5 kg, p&amp;lt;0.0001), BMI -5.0±3.5 kg/m2 (from 38.9 kg/m2, p&amp;lt;0.0001), HbA1c -0.3±0.3% (from 5.9±0.2%, p&amp;lt;0.0001), fasting glucose -9±14 mg/dL (from 110±15 mg/dL, p&amp;lt;0.0001), systolic BP -6±14 mmHg (from 130±13 mmHg, p=0.0003), diastolic BP -3±9 mmHg (from 83±8 mmHg, p=0.0032), triglycerides -43±55 mg/dL (from 148±67 mg/dL, p&amp;lt;0.0001), and HDL-C +7±9 mg/dL (from 52±14 mg/dL, p&amp;lt;0.0001). Seventy percent (54/77) of participants lost &amp;gt;7% body weight. At 1 year, 51.1% (45/88) participants achieved fasting glucose &amp;lt;100 mg/dL (up from 24/94, 25.5% at baseline). No completer progressed to T2D, and 60.7% (54/89) achieved HbA1c &amp;lt;5.7% (up from 14/94, 14.9% at baseline). Most participants (56.3%, 54/96) maintained mean blood beta-hydroxybutyrate concentrations ≥0.5 mmol/L, indicating moderate adherence to nutritional advice. These results demonstrate that patients with preT2D can be supported remotely with this continuous care model to improve risk factors associated with progression of preT2D to T2D. Ongoing research will evaluate the continued sustainability of this intervention and prevention of T2D. Disclosure A. McKenzie: Employee; Self; Virta Health Corp.. Stock/Shareholder; Self; Virta Health Corp. S. Hallberg: Board Member; Spouse/Partner; Atkins Nutritionals, Inc.. Employee; Self; Virta Health. Stock/Shareholder; Self; Virta Health. N.H. Bhanpuri: Employee; Self; Virta Health Corp.. Stock/Shareholder; Self; Virta Health Corp. S.J. Athinarayanan: Employee; Self; Virta Health Corp. J. McCue: Employee; Self; Virta Health Corp.. Stock/Shareholder; Self; Virta Health Corp. J.P. McCarter: Employee; Self; Virta Health Corp.. Stock/Shareholder; Self; Virta Health Corp. J. Volek: Stock/Shareholder; Self; Virta Health Corp.. Advisory Panel; Self; Atkins Nutritionals, Inc.. Other Relationship; Self; Beyond Obesity. S. Phinney: Employee; Self; Virta Health Corp.. Advisory Panel; Self; Atkins Nutritionals, Inc..

Prevalence and its risk factors of diabetic patients in urban area of Palakkad: an observational study

Background: Diabetes mellitus (DM) is emerging as a major health-care challenge for India. The worldwide prevalence of DM has risen dramatically in the developing countries over the past two decades. Most studies from western countries and urban studies of India point out that lifestyle changes, sedentary life, diet and related epidemiological transition as major risk factors in the development of DM. Methods: It was a cross sectional observational study done in urban area covered under urban primary health Centre (UPHC) of Govt. Medical College, Palakkad. Adults more than 30 years of age in urban area were included and observation period was from 2016-2017. Results: The overall prevalence of diabetes mellitus in the present study was found to be 268 (65.68%). In this 135 (50.37%) were the age group is 50-59 years and almost half 80 (29.85%) were diagnosed at the age of 40-49 years. Similarly, the risk factors such as age, occupation, diet, smoking, alcohol, truncal obesity and family history were significantly associated with prevalence of T2DM whereas alcohol and hypertension were not. Conclusions: The result of the present study proves that prevalence of T2DM was influenced by many risk factors like age, diet, dyslipidaemia, truncal obesity and family history consider more important in the urban studies.

Effects of Glucomannan Noodle on Diabetes Risk Factors in Patients with Metabolic Syndrome: A Double-Blinded, Randomized Crossover Controlled Trial

Glucomannan is a water-soluble dietary fiber derived from the root of Amorphophallus konjac that can improve blood sugar, blood fat concentration, and weight management, and has other health benefits. The aim of this study is to investigate the effect of glucomannan noodles on components of the metabolic syndrome. A randomized, double-blind, placebo-controlled, crossover study, 32 individuals with metabolic syndrome were received a daily servings of 400 gram glucomannan noodles for a period of four weeks. After two weeks of wash out period, they received a placebo noodles for four weeks. There were no statistical difference in calories, carbohydrate, protein, fat and dietary fiber intake from 24 h food recalls between glucomannan noodles and placebo noodles groups. However, the body weight, body mass index, and waist circumference had significantly decreased after 4-week intervention in both groups, but high sensitivity C-reactive protein was lowered only in glucomannan noodles group. Moreover, the 24 individuals with type 2 diabetes had significantly decreased body weight, BMI, waist circumference, hs-CRP, and glycated hemoglobin after glucomannan noodles intervention. The rest of lipid profile, fasting blood glucose, insulin, and HOMA-IR of the subjects did not show any significant difference. This study showed that glucomannan noodles as a staple food can contribute to metabolic syndrome in adults predisposed to type 2 diabetes.

Effect of nurse-led randomised control trials on cardiovascular risk factors and HbA1c in diabetes patients: A meta-analysis.

A systematic review and meta-analysis identified 42 randomised control trials comparing a nurse-led intervention with 'usual care' to quantify their effect on glycated haemoglobin (HbA1c) and major cardiovascular risk factors in diabetes patients. All relevant databases were systematically searched for publications to February 2016: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE and Cumulative Index to Nursing & Allied Health Literature (CINAHL). The 42 trials recruited 9955 diabetes patients (5022 randomised to intervention and 4933 to 'usual care'). For patients receiving the nurse-led intervention, compared with 'usual care', there were small but significant mean reductions for HbA1c [-0.28%; 95% CI -0.38%, -0.18%; p-value<0.0001, n=6920] and serum triglyceride levels [-0.27mmol/L; 95% CI -0.49, -0.06; p=0.01, n=1169], and a greater proportion of patients stopped smoking [risk ratio=2.70; 95% CI 1.35, 5.43; p=0.005, n=1890 patients]. Mean reductions for systolic [-1.84mmHg; 95% CI -3.97, -0.10; p=0.06, 4241 patients] and diastolic [-0.95mmHg; 95% CI -2.15, -0.25; p=0.12, 3811 patients] blood pressures trended towards significance. There were no significant mean reductions for body mass index or serum cholesterol. Nurse-led interventions produced greater improvements than 'usual care' for HbA1c, serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management.

The Durability of Basal Insulin Affects Day-to-Day Glycemic Variability Assessed by Continuous Glucose Monitoring in Type 2 Diabetes Patients: A Randomized Crossover Trial.

Not only within-day glycemic variability but also day-to-day glycemic variability is a risk factor for diabetic patients. However, the ways of controlling day-to-day glycemic variability are unclear. We hypothesized that the durability of basal insulin plays an important role in controlling day-to-day glycemic variability in type 2 diabetes patients, and we therefore aimed to evaluate whether glargine U300, which exhibits prolonged absorption compared with glargine U100 but the same composition as glargine U100, would lead to improved day-to-day glycemic variability. This was a single-center, randomized, open-label, crossover study in type 2 diabetes patients using basal insulin therapy. After switching from 4 weeks of treatment with glargine U100 or U300, the patients performed continuous glucose monitoring (CGM) for 72 h in an environment with routine activities and mealtimes. The mean of daily difference (MODD) was assessed as day-to-day glycemic variability. We enrolled 22 patients, and 17 patients completed the study. The MODD assessed as day-to-day glycemic variability was significantly lower with glargine U300 than with glargine U100 (1.8 ± 0.6 mmol/L vs. 2.4 ± 0.9 mmol/L, P = 0.006). No significant difference was observed in short-term glycemic variability between the two glargine formulations as measured by the standard deviation, coefficient of variation, mean amplitude of glucose excursion. Compared with glargine U100 treatment, glargine U300 treatment improved the MODD as assessed by CGM in type 2 diabetes patients. These findings suggest that the durability of basal insulin may be associated with day-to-day glycemic variability in type 2 diabetes patients.

133: THE EFFECT OF ZINGIBER OFFICINALE (GINGER) ON HYPERTENSION; A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS

Background and aims:Zingiber Officinale, commonly known as ginger, has been widely used traditionally in the daily diet and a variety of medicinal purposes. There are some animal studies on the...

Evaluating the significance of hypoglycemia in promoting insulin induced hypertension by using a glucose clamp model

Background: Hypoglycemia unawareness is a detrimental risk factor in diabetic patients leading to serious complications if left untreated. Previous studies from our group determined that recurrent insulin induced hypoglycemia (RIIH) promotes hypertension.Objective: We hypothesize that RIIH not insulin by itself is the source of hypertension and end organ damage in diabetic patients.Methods: Male Sprague-Dawley-rats (200-250g, n=18) were provided with glucose food (125g glucose/kg body weight) and glucose water (0.1g glucose/100g body weight/ml). They were treated with subcutaneous insulin injections (7U/Kg) and blood glucose was monitored intermittently. Daily blood pressure was measured using the tail cuff method. Interstitial samples of ATP and angiotensinII (AngII) were collected by renal microdialysis and analyzed using luciferin-luciferase bioluminescent assay and EIA respectively. Reactive oxygen and nitrogen species in hearts and kidneys were analyzed using Electron Paramagnetic Resonance Spectroscopy (EPR).Results: Renal interstitial ATP levels increased from 90.2± 4.7ng/µl to 99.6± 8.7ng/µl (not significant) and AngII from 0.15± 0.02ng/ml to 0.13± 0.05ng/ml (not significant) from day 0 to 14. There was no significant change in mean arterial pressure (121.3 ± 1.4 mmHg on day 0 to 127.8 ± 1.4mmHg on day 14). Oxidative stress was reduced compared to RIIH model, which was evident from the EPR spectra.Conclusion: We demonstrated that hypertension induced end organ damage in diabetics is due to insulin induced hypoglycemia not insulin alone (by itself).

DIABETES PATIENT AND MYOCARDIAL REVASCULARIZATION FROM THE EVIDENCE GUIDED PERSPECTIVE: CARDIOLOGIST OPINION. PART 2

The review focuses on the recent state of the prescription problem of glucose lowering medications in perioperational period for myocardial revascularization in diabetes patients. The positions provided, from current clinical guidelines of the main societies on diabetes and cardiovascular diseases investigation, as the issues highlighted that are not evident enough yet. Studies results described of different strategies for this category of patients management. The significance is shown, of the importance of glucose metabolism compensation in myocardial revascularization, and the fact confirmed, that too strict glycemia control is not beneficial for neither percutaneous, nor open coronary intervention. Main glucose lowering drugs groups are described in an aspect of their influence on cardiovascular system according to the data from the completed trials. The significance is proved of a complex control for the main risk factors in diabetes patients during coronary intervention.