Role Of Glycemic Control Research Articles

Role of glycemic control on lipid profile in patients with type 2 diabetes mellitus-a cross-sectional study in tertiary care hospital of West Bengal

Role of glycemic control on lipid profile in patients with type 2 diabetes mellitus-a cross-sectional study in tertiary care hospital of West Bengal

Evaluation of the adherence to antidiabetic medications among Iraqi patients with T2DM using the Iraqi antidiabetic medication adherence scale (IADMAS)

Background and Aims: Management of diabetes is a multifactorial process, and adherence to treatment programs plays a role in glycemic control. The present study evaluates the adherence rate to the antidiabetic medications with a newly developed scale and patients’ HbA1c levels among Iraqi patients with type-2 diabetes. Methods: A cross-sectional study among adult patients receiving diabetic care in public and private healthcare settings within Baghdad City was conducted. The medication adherence was evaluated using the Iraqi Antidiabetic Medication Adherence Scale (IADMAS) to determine the factors associated with non-adherence to anti-diabetic medications. Glycated hemoglobin (HbA1c) levels of the participants were used as an indicator of glycemic status. Results: The outcome measures include the comparison between glycemic status and the claims of antidiabetic medication adherence of patients with T2DM, in addition to the expected benefits to clinical practice. A total of 442 patients with type 2 diabetes participated in the study and responded by completing the given questionnaire (response rate: 96.1%). The prevalence of non-adherence to medication was reported to be no more than 30%. Adherence based on HbA1c values reflected a high false-positive value of adherence with an extremely high true negative value. The adherence of Iraqi patients to their medications demonstrated a high negative predictive value (0.905) and a high sensitivity (0.928) with low specificity (0.156) values. Conclusion: The use of IADMAS in this study failed to confirm the consistency between the apparent claims of adherence to anti-diabetic medications and the HbA1c value as a marker of glycemic control.

The effect of toll-like receptor ligands on energy metabolism and myokine expression and secretion in cultured human skeletal muscle cells

Skeletal muscle plays an important role in glycaemic control and metabolic homeostasis, making it a tissue of interest with respect to type 2 diabetes mellitus. The aim of the present study was to determine if ligands of Toll-like receptors (TLRs) could have an impact on energy metabolism and myokine expression and secretion in cultured human skeletal muscle cells. The myotubes expressed mRNA for TLRs 1–6. TLR3, TLR4, TLR5 and TLR6 ligands (TLRLs) increased glucose metabolism. Furthermore, TLR4L and TLR5L increased oleic acid metabolism. The metabolic effects of TLRLs were not evident until after at least 24 h pre-incubation of the cells and here the metabolic effects were more evident for the metabolism of glucose than oleic acid, with a shift towards effects on oleic acid metabolism after chronic exposure (168 h). However, the stimulatory effect of TLRLs on myokine expression and secretion was detected after only 6 h, where TLR3-6L stimulated secretion of interleukin-6 (IL-6). TLR5L also increased secretion of interleukin-8 (IL-8), while TLR6L also increased secretion of granulocyte–macrophage colony stimulating factor (GM-CSF). Pre-incubation of the myotubes with IL-6 for 24 h increased oleic acid oxidation but had no effect on glucose metabolism. Thus IL-6 did not mimic all the metabolic effects of the TLRLs, implying metabolic effects beyond the actions of this myokine.

J-curve relationship between long term glycemic control and mortality in diabetic patients with acute myocardial infarction undergoing percutaneous coronary intervention

BackgroundIntensive glycemic control is generally recommended for diabetic patients to reduce complications. However, the role of glycemic control in the mortality in diabetic patients with acute myocardial infarction (AMI) remained unclear.MethodsWe selected diabetic patients who measured HbA1c more than 3 times after AMI among 10,719 patients enrolled in the multicenter AMI registry. Patients (n = 1384) were categorized into five groups: according to mean HbA1c level: ≤ 6.5%, > 6.5 to ≤ 7.0%, > 7.0 to ≤ 7.5%, > 7.5 to ≤ 8.0% and > 8.0%. The primary endpoint was all-cause mortality.ResultsDuring a median follow-up of 6.2 years, the patients with a mean HbA1c of 6.5 to 7.0% had the lowest all-cause mortality. Compared to patients with mean HbA1c of 6.5 to 7.0%, the risk of all-cause mortality increased in subjects with mean HbA1c ≤ 6.5% (adjusted hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.02–3.95) and in those with mean HbA1c > 8.0% (adjusted HR 3.35, 95% CI 1.78–6.29). In the subgroup analysis by age, the J-curve relationship between mean HbA1c and all-cause mortality was accentuated in elderly patients (age ≥ 65 years), while there was no difference in all-cause mortality across the HbA1c groups in younger patients (age < 65 years).ConclusionsThe less strict glycemic control in diabetic patients with AMI would be optimal for preventing mortality, especially in elderly patients.

Effects of tofogliflozin on adrenocorticotropic hormone, renin and aldosterone, and cortisol levels in elderly patients with diabetes mellitus: A retrospective study of a patient cohort.

Adrenocorticotropic hormone (ACTH) and cortisol reportedly play a role in glycemic control in patients with type 2 diabetes mellitus (T2DM); however, the underlying mechanism remains controversial. We retrospectively investigated the effect of tofogliflozin on serum ACTH and cortisol levels in elderly patients with T2DM.Patients received 20 mg tofogliflozin daily for 3 months. Serum ACTH and cortisol levels were measured at baseline, as well as after 1 month and 3 months of tofogliflozin therapy.Serum ACTH levels were significantly reduced 3 months after tofogliflozin treatment (P < .01). Additionally, serum cortisol levels were reduced 3 months after tofogliflozin treatment, demonstrating borderline significance (P = .05). The higher body mass index (BMI; ≥25 kg/m2) group showed higher ACTH and cortisol levels than the lower BMI (<25 kg/m2) group, with borderline significance (P = .05). Renin levels were significantly increased 1 month after treatment (P < .05), maintaining serum aldosterone levels in parallel with the extracellular fluid.Our findings suggested that tofogliflozin decreased both serum ACTH and cortisol levels, with higher levels observed in the high BMI group. Tofogliflozin increased serum renin levels while maintaining serum aldosterone and extracellular fluid levels. Collectively, tofogliflozin could affect the hypothalamic-pituitary-adrenal pathway in patients with T2DM, especially in the low BMI group.

Social inequalities in the self-management of type 1 diabetes: A serial multiple mediation analysis.

Diabetes requires complex self-management. Due to this complexity, social disparities exist in the self-management of type 1 diabetes. Various pathways to describe associations between socio-economic factors and health outcomes have been suggested. We sought to elucidate the potential of health literacy and social support to reduce social disparities in diabetes self-management. Questionnaire responses were linked to data from electronic medical records, yielding a study population of 1186 people with type 1 diabetes. Mediation analyses using adjusted linear regressions were used to establish pathways between self-reported educational attainment, social support, functional health literacy and clinically obtained measures of glycaemic control. We found evidence of an association between education and glycated haemoglobin, partially mediated by functional health literacy and social support. However, the direct association between social support and glycaemic control was not statistically significant. Whilst both functional health literacy and social support play a role in glycaemic control, our findings did not explain the main impact of social disparities on glycaemic control. Interventions to reduce disparities in glycaemic control related to educational attainment should focus beyond functional health literacy and social support.

Factors Affecting Glycemic Control in Diabetes Mellitus Patients

Introduction : Indonesia ranked seventh in the prevalence of diabetes mellitus in the world. Improved glycemic control has been proven to prevent the diabetes and its complications. Adherence to treatment, weight regulation with benchmarks for Body Mass Index (BMI) indicators, activity or exercise habits, diet, and smoking history play an important role in glycemic control. Objective: The aim of this study was to identify factors affecting glycemic control in outpatient with diabetes mellitus. Methods: A cross sectional study among 32 diabetes mellitus patients.This study was conducted from April 2019 to September 2019 at Rumah Sakit Nasional Diponegoro (RSND), Semarang. The glycemic control status were assesed by HbA1c. Factors such medication adherence, diet adherence, smoking status, and physical activity were assesed with a structured questionnaire. Anthropometric measurement done to get the BMI status. Data were analyzed with bivariat analysis with chi square test (p<0.05). Result: The factors that were significantly have relationship with glycemic control status are diet adherence (p=0.046), and medication adherence (p=0.040). Physical activity, smoking status and BMI doesn’t have significant relationship with glycemic control status. Conclusion: Factors affecting glycemic control of diabetes mellitus patients in this study were diet adherence and medication adherence. History of smoking, BMI, and physical activity were not factors that influenced the control status in diabetes mellitus patients in this study.

A Video Game for Brazilian T1D Children about Knowledge of Disease and Self-care: A Methodological Study.

Video games are interactive technologies able to support children in health promotion, behavior changes, and chronic disease self-management. The use of health behavior change determinants in video game design can increase its effectiveness. This study describes the process of designing a video game for Brazilian children with T1D clarifying the use of health behavior change determinants that may influence self-management behaviors. This was a methodological study based on health behavior change theories and the user-centered design approach. The results of a qualitative study conducted with children aged 7 to 12 years identified learning needs about knowledge on diabetes and self-care tasks which contribute to inappropriate behaviors. A Behavioral Diagnosis presented health behavior change determinants, capable of influencing children's learning needs and behaviors, that were considered to design The Heroes of Diabetes-the power of knowledge. The results presented the process of designing 4 mini games with its description and theory foundation to reach children's lack of understanding about T1D, insulin's role, SMBG requirements, food groups and physical activity's role in glycemic control. Knowledge, goal settings, extrinsic and intrinsic motivation determinants were related with video games design features. The findings support the use of health behavior change determinants into video game design as a guide to achieve children learning needs and that might influence self-management behaviors.

Inducible Pluripotent Stem Cells as a Potential Cure for Diabetes.

Over the last century, diabetes has been treated with subcutaneous insulin, a discovery that enabled patients to forego death from hyperglycemia. Despite novel insulin formulations, patients with diabetes continue to suffer morbidity and mortality with unsustainable costs to the health care system. Continuous glucose monitoring, wearable insulin pumps, and closed-loop artificial pancreas systems represent an advance, but still fail to recreate physiologic euglycemia and are not universally available. Islet cell transplantation has evolved into a successful modality for treating a subset of patients with ‘brittle’ diabetes but is limited by organ donor supply and immunosuppression requirements. A novel approach involves generating autologous or immune-protected islet cells for transplant from inducible pluripotent stem cells to eliminate detrimental immune responses and organ supply limitations. In this review, we briefly discuss novel mechanisms for subcutaneous insulin delivery and define their shortfalls. We describe embryological development and physiology of islets to better understand their role in glycemic control and, finally, discuss cell-based therapies for diabetes and barriers to widespread use. In response to these barriers, we present the promise of stem cell therapy, and review the current gaps requiring solutions to enable widespread use of stem cells as a potential cure for diabetes.

Poor glycaemic control is associated with increased risk of neurodevelopmental disorders in childhood-onset type 1 diabetes: a population-based cohort study

Aims/hypothesisThe aim of this study was to investigate the effect of childhood-onset type 1 diabetes on the risk of subsequent neurodevelopmental disorders, and the role of glycaemic control in this association. We hypothesised that individuals with poor glycaemic control may be at a higher risk of neurodevelopmental disorders compared with the general population, as well as compared with individuals with type 1 diabetes with adequate glycaemic control.MethodsThis Swedish population-based cohort study was conducted using data from health registers from 1973 to 2013. We identified 8430 patients with childhood-onset type 1 diabetes (diagnosed before age 18 years) with a median age of diabetes onset of 9.6 (IQR 5.9–12.9) and 84,300 reference individuals from the general population, matched for sex, birth year and birth county. Cox models were used to estimate the effect of HbA1c on the risk of subsequent neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability.ResultsDuring a median follow-up period of 5.6 years, 398 (4.7%) individuals with type 1 diabetes received a diagnosis of any neurodevelopmental disorder compared with 3066 (3.6%) in the general population, corresponding to an adjusted HR (HRadjusted) of 1.31 (95% CI 1.18, 1.46) after additionally adjusting for other psychiatric morbidity prior to inclusion, parental psychiatric morbidity and parental highest education level. The risk of any neurodevelopmental disorder increased with HbA1c levels and the highest risk was observed in patients with mean HbA1c >8.6% (>70 mmol/mol) (HRadjusted 1.90 [95% CI 1.51, 2.37]) compared with reference individuals without type 1 diabetes. In addition, when compared with patients with diabetes with HbA1c <7.5% (<58 mmol/mol), patients with HbA1c >8.6% (>70 mmol/mol) had the highest risk of any neurodevelopmental disorder (HRadjusted 3.71 [95% CI 2.75, 5.02]) and of specific neurodevelopmental disorders including ADHD (HRadjusted 4.16 [95% CI 2.92, 5.94]), ASD (HRadjusted 2.84 [95% CI 1.52, 5.28]) and intellectual disability (HRadjusted 3.93 [95% CI 1.38, 11.22]).Conclusions/interpretationChildhood-onset type 1 diabetes is associated with an increased risk of neurodevelopmental disorders, with the highest risk seen in individuals with poor glycaemic control. Routine neurodevelopmental follow-up visits should be considered in type 1 diabetes, especially in patients with poor glycaemic control.Graphical abstract

Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control.

Type 1 diabetes (T1D) is a known risk factor for fractures, but the underlying pathophysiology is still not fully understood. This study aims to define age peaks and frequent fracture sites of children and young adults with T1D. Additionally, associations of fractures with metabolic and lifestyle factors as well as with additional complications in individuals with T1D were analyzed. A total of 750 individuals with T1D aged ≤25 years with fractures were matched to 3750 patients with T1D without fractures by demographics and insulin regimen. Hemoglobin A1c (HbA1c) values were compared using linear regression, and logistic regression was used to calculate odds ratios (OR) for fractures in individuals with acute complications and diseases. Median (Q1-Q3) age was 12.7 (9.9 to 14.9) years in individuals with fractures and 16.3 (12.6 to 17.8) years in the entire control group with 65% versus 53% males. Peak age for fractures was 7 to <15 years in males and 9 to <11 years in females, which is earlier than reported for the general population. HbA1c (%) was significantly higher in individuals with fractures than in controls (difference of estimated means: 0.26%; 95% confidence interval [CI] 0.07-0.46), especially in postpubertal females (0.68; 0.10-1.26). Significantly higher odds for fractures were observed in individuals with severe hypoglycemia (OR=1.90; 95% CI 1.47-2.47), especially in prepubertal females (OR=2.81; 1.21-6.52]) and postpubertal males (2.44; 1.11-5.38), celiac disease (2.02; 1.67-2.45), and with a history of smoking (1.38; 1.02-1.88). The age peak of fractures seems to be earlier in T1D than in the general population. Poor glycemic control is related to fractures, even before puberty. Associations of HbA1c and severe hypoglycemia with fractures highly depend on age and sex. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

November 2020 at a glance: focus on comorbidities and medical treatment.

The role of glycaemic control in patients with heart failure (HF) and concomitant diabetes is controversial. Insulin treatment is associated with poorer outcomes in these patients.1, 2 McAlister et al.3 investigated the relationship between glycaemic control, i.e. glycated haemoglobin (HbA1c), and cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus and atherosclerosis from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Results showed a U-shaped association between baseline HbA1c and CV outcome, with the lowest risk when HbA1c was around 7%.3 Iron deficiency impairs cardiac contractility through decreased mitochondrial function.4 Hirsch et al.5 assessed iron concentrations in non-ischaemic HF with reduced ejection fraction (HFrEF), using endomyocardial biopsies. Lower iron concentrations were associated with a greater severity of HF. Hyperkalaemia is frequent in HFrEF patients, above all when on renin–angiotensin–aldosterone system inhibitors.6, 7 An administrative database analysis showed the association of hyperkalaemia with mortality and CV events in HF patients on renin–angiotensin–aldosterone system inhibitors.8 In the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) trial, both hypokalaemia and hyperkalaemia were associated with a higher risk of CV death, compared with potassium levels between 4.1 and 4.9 mmol/L (hazard ratio 2.40 and 1.42, respectively). No interaction between serum potassium and sacubitril/valsartan efficacy vs. enalapril was found.9 Frailty is a major independent determinant of outcomes in HF.10 A new Frailty Score has recently been developed.11 The FRAGILE-HF study was a prospective multicentre study investigating the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in patients hospitalized with HF. Patients with a greater number of frailty domains had higher mortality and HF rehospitalization.12 The prevalence of frailty is increased in HF with preserved ejection fraction (HFpEF) patients and is associated with worse outcome.13 Similarly, frailty was highly prevalent in HFrEF patients and was associated with poor quality of life and outcomes in a retrospective analysis of PARADIGM-HF and ATMOSPHERE.14 Biomarkers, namely natriuretic peptides, play a major role in the management of HF.15 Aimo et al.16 analysed the prognostic value and the influence of age on circulating levels of biomarkers in 5301 patients with chronic HF. N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT) and soluble suppression of tumorigenesis-2 (sST2) predicted outcomes. sST2 was less influenced by age than the other two biomarkers. In the Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction (PARAGON-HF) trial, serum uric acid (SUA) was an independent predictor of poor outcome in HFpEF. Sacubitril/valsartan reduced SUA levels and the need for SUA-related drugs.17 Sex-based differences in biomarkers, health status, and reverse cardiac remodelling in HFrEF patients treated with sacubitril/valsartan in the Prospective Study of Biomarkers, Symptom Improvement and Ventricular Remodelling During Entresto Therapy for HF (PROVE-HF) were analysed by Ibrahim et al.18 Sex is a major determinant of clinical characteristics and outcomes in patients with HFrEF and HFpEF.19-21 In the study by Ibrahim et al.18, women treated with sacubitril/valsartan had more rapid reduction in NT-proBNP plasma levels and reverse cardiac remodelling and a larger improvement in quality of life. McEwan et al.22 showed the cost-effectiveness of dapagliflozin for the treatment of HFrEF with significant life-year and quality-adjusted life-year gains for the patients treated. The Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in HF (GALACTIC-HF) trial assessed the safety and efficacy of the cardiac myosin activator omecamtiv mecarbil in HFrEF patients. The baseline characteristics of enrolled patients are presented in this issue. The trial enrolled well-treated and high-risk inpatients and outpatients, representative of recent HF registries and trials.23

The significance of hyperglycaemia and other comorbidities during the COVID‐19 pandemic

The significance of hyperglycaemia and other comorbidities during the <scp>COVID</scp>‐19 pandemic

Correlation Between Serum Magnesium Level and Hba1c in Glycemic Control of Type 2 Diabetes Mellitus

Background: Type II Diabetes Mellitus is characterized by impaired insulin secretion and resistance to insulin action resulting in hyperglycemia. Magnesium plays an important role in insulin secretion, insulin binding, and homeostasis. Magnesium acts directly on glucose metabolism through its role as a cofactor in the phosphorylation of glucose. Hypomagnesaemia is often left undiagnosed in diabetic subjects. Recent studies reveal that chronic deficiency of magnesium may contribute to systemic inflammation and insulin resistance. Aim: The study is to find the correlation between serum Magnesium level and HbA1c in glycemic control of Type 2 Diabetes mellitus patients. Materials and Method: This is a prospective observational study conducted by analyzing the HbA1C and Serum Magnesium in a tertiary care hospital, Chennai. We categorized into three different study population, to find out whether there is any correlation between magnesium levels and glycemic control in diabetic patients. The obtained values were subjected to statistical analysis by Analysis of variance with post hoc analysis and determination of correlation coefficient. Results: The results proved that the HbA1c and the serum magnesium levels showed inverse variation each other. Conclusion: The results proved that if serum magnesium values are made to rise, glycemic control is better and HbA1c values will fall thus proving that serum magnesium plays a major role in glycemic control. Hence, its association with HbA1c value, which indicates the level of glycemic control, would be, if found out, a very valuable addition to the fund of knowledge in healthcare.

Stress hyperglycaemia is associated with poor functional outcomes in patients with acute ischaemic stroke after intravenous thrombolysis.

Transient hyperglycaemia in the context of illness with or without known diabetes has been termed as 'stress hyperglycaemia'. Stress hyperglycaemia can result in poor functional outcomes in patients with acute ischaemic stroke (AIS) who underwent mechanical thrombectomy. We investigated the association between stress hyperglycaemia and clinical outcomes in AIS patients undergoing intravenous thrombolysis (IVT). We examined 666 consecutive patients with AIS who underwent IVT from 2006 to 2018. All patients had a glycated haemoglobin level (HbA1c) and fasting venous blood glucose measured within 24 h of admission. Stress hyperglycaemia ratio (SHR) was defined as the ratio of the fasting glucose to the HbA1c. Univariate and multivariate analyses were employed to identify predictors of poor functional outcomes (modified Rankin Scale 3-6 at 3 months) after IVT. Three-hundred and sixty-one patients (54.2%) had good functional outcomes. These patients tended to be younger (60.7 ± 12.7 vs. 70 ± 14.4 years, P < 0.001), male (70.7% vs. 51.5%, P < 0.001), had lower prevalence of atrial fibrillation (13.0% vs. 20.7%, P = 0.008) and lower SHR (0.88 ± 0.20 vs. 0.99 ± 26, P < 0.001). Patients with high SHR (≥0.97) were slightly older than those with low SHR (<0.97) and were more likely to have diabetes mellitus. On multivariate analysis, higher SHR was independently associated with poor functional outcomes (adjusted odds ratio 3.85, 95% confidence interval 1.59-9.09, P = 0.003). SHR appears to be an important predictor of functional outcomes in patients with AIS undergoing IVT. This may have important implications on the role of glycaemic control in the acute management of ischaemic stroke.

Antidiabetic Effects of Physical Activity: How It Helps to Control Type 2 Diabetes.

Despite the improvements in clinical care of the patients, research updates, and public health interventions, there is still an increase in the prevalence, incidence, and mortality because of diabetes mellitus (DM). DM is a public health problem in both developed and developing countries. It has increased alarmingly, putting this disease in the dimension of an epidemic. Diabetes is associated with several complications which increase the risk of many serious health problems on the other side. Therefore, this review was aimed to discuss the antidiabetic effects of physical activity (PA) on type 2 DM (T2DM) by summarizing the significant studies on this topic. This review found that several studies have recommended the utilization of PA for the effective management of T2DM. PA is a non-pharmacologic therapy which is a significant strategy for the management of T2DM and is an appropriate lifestyle modification approach to be practiced by these patients. The studies showed that PA has antidiabetic effects which are evidenced by its substantial role in improving the blood glucose (BG) levels of the individuals with T2DM where it helps them to control their levels of glucose in the blood. It plays a significant role in glycemic control of this disease by lowering the BG levels through possible mechanisms such as decreasing insulin resistance, increasing production of glucose transporter type 4 (GLUT-4), lowering visceral adipose tissue (VAT), increasing pancreatic β-cell functions, using glucose for energy, and so on. In turn, the controlled glycemia helps to prevent the complications associated with uncontrolled T2DM and this would further improve the overall health of the patients and the burden on the health professionals as well. Finally, this review concludes that PA is the cornerstone in the management of T2DM. It also suggests that more attention is needed to its significance in the prevention, glycemic control, and its role in the management of the morbidity and mortality associated with T2DM. Practical PA recommendations and suggestions for the future direction of research in this area are also provided.

A study to assess the treatment adherence among patients with type 2 diabetes mellitus in rural and urban population of Bengaluru, South India

Background: Globally, around 425 million adults are victims of diabetes with increased prevalence being noted in low and middle income countries. Diabetes was seventh leading cause of death leading to 1.6 million deaths in 2016 (WHO report). Management of diabetes is multifaceted which includes diet, physical activity, screening for complications and medications. Adherence to pharmacotherapy plays an important role in glycemic control. Hence, this study was done to assess the magnitude of treatment adherence and its associated factors among type 2 diabetics.Methods: A community based study was done on patients with type 2 DM in the rural and urban population of Bengaluru. A simple random sampling technique was followed. Medication adherence was assessed using 8 item Morisky's treatment adherence scale.Results: A total of 250 subjects were interviewed, among them 59% were male and 41% were female. The mean age of the subjects was 60.93±10.1 years. The mean treatment adherence scores was 25.9±3.1 years. Among the 250 diabetics, 62% were adherent and 38% were non adherent to anti diabetic medications. Forgetfulness to take medications was one of the reasons for non-adherence with mean scores of 3.12+0.6.Being illiterate, labourers, aged above 60 years, obesity, frequency and multiple dosage was found to be significant factors for non-adherence (p&lt;0.05).Conclusions: Adherence to anti diabetic drugs was found to be 62%. Increased age, illiteracy, occupation, BMI, frequency and multiple doses of drugs were significant factors responsible for medication non adherence. There is a need for reinforcement of health education and motivation for diabetics to improve their medication adherence.

Study of insulin to glucagon ratio and its correlation with thyroid hormones in streptozotocin induced type 2 diabetes.

A number of endocrine hormones play a significant role in glycemic control of the body. Insulin and glucagon are two contrasting hormones which work in close association to maintain a normal fuel balance. Thyroid hormones also have a key role in regulating blood glucose levels. Several studies have suggested that type 2 diabetes mellitus (T2DM) have increased incidence of thyroid abnormalities. Objectives: To determine correlation between insulin to glucagon ratio and thyroid hormones levels in the two groups. Study Design: Randomized Control Trial. Settings: Physiology Department of Army Medical College, Rawalpindi and National Institute of Health (NIH), Islamabad. Period: 6 months (from 1st January 2017 to 30th June 2017). Material &amp; Methods: A sample of sixty apparently healthy Sprague Dawley rats was selected randomly. It was divided into two groups i.e control and diabetic. It was ensured that all the rats were euglycemic and euthyroid at the start of the study by investigating serum thyroid stimulating hormone (TSH) and serum glucose levels. The control group was given with normal pellet diet whereas, STZ induced rats were fed on high fat diet while. The control group were injected with saline injection intraperitoneally after 2 weeks, while low dose of streptozotocin was injected to diabetic rats. The induction of diabetes mellitus was affirmed by checking plasma glucose levels and homeostatic model for insulin resistance (HOMA-IR). The specific diet was continued for another five weeks in both the groups. The terminal sample was investigated for plasma glucose using glucose oxidase method and serum insulin, TSH, T3 and T4 levels using ELISA technique. Results: The serum insulin and glucose levels were elevated in diabetic group as compared to the control group. HOMA-IR was also raised significantly in the diabetic group. The serum TSH and T4 levels were considerably higher (p˂0.001) while serum T3 was comparable in both the groups. There was no correlation between Insulin to Glucagon Ratio and TSH, T3 and T4 both in control and diabetic groups. Conclusion: Serum glucose, serum insulin and HOMA-IR were raised in the diabetic group. Serum TSH and T4 levels were also increased while no change in serum T3 levels. IGR and thyroid hormones were not correlated in either group.

MON-624 Effect of Whole Body Vibration on Glycemic Control in Adults with Type 2 Diabetes

Introduction: Physical activity plays an important role in glycemic control in patients with type 2 diabetes, but overall adherence rate is low. For patients not able or willing to engage in regular physical exercise, whole body vibration comes as a potential alternative. Objective: To evaluate the effect of 28Hz whole body mechanical vibration on glycemic control and other metabolic parameters in patients with type 2 diabetes. Methods: 24 adults with type 2 diabetes on oral antidiabetic agents, with a baseline HbA1c between 6.5 and 9.0%, were randomized into two groups. The control group (CG) was advised to adopt lifestyle modifications, and the intervention group (IG) received the same orientations and used a 28 Hz whole body vibrating platform daily for 20-30 minutes during 12 weeks. Results: Data from 22 patients were analyzed (one from each group was excluded). Baseline characteristics of both groups were similar except for triglycerides, which were higher in the CG (111.8±39.9 mg/dL vs. 188.9±68.8 mg/dL, p<0.05). After 12 weeks, there was a significant reduction in glycated hemoglobin in the IG (7.69±0.49 vs. 7.17±0.77%, p<0.05), not observed in the CG (8.05±0.98 vs. 7.92±1.07%, p=0.52). A non-significant trend for weight loss in IG was observed (78.14±10.47 vs. 77.14±11.08Kg, p=0.069). There were no significant differences between the groups regarding fasting blood glucose or any other clinical and biochemical variables analyzed. Conclusion: This study suggests an improvement in glycated hemoglobin at 12 weeks with the use of the 28Hz vibration platform in patients with type 2 diabetes. However, further studies with a larger number of patients and longer follow-up are needed to better define the role of whole body vibration as an adjuvant in glycemic control.

Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database

BackgroundThe prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population. Methods3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70–6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): <7% (n = 266), 7.1–8% (n = 133), >8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death. ResultsFor all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis. ConclusionIn HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control.