Significant Decrease In HbA1c Research Articles

Comparative Study of Low-dose Pioglitazone or Metformin Treatment in Japanese Diabetic Patients with Metabolic Syndrome

The aim of this study was to determine whether a relatively low dose of pioglitazone or metformin was effective in diabetic patients with metabolic syndrome. Fifty diabetic patients with metabolic syndrome were randomly assigned to a low-dose pioglitazone (15 mg/day) treatment group or a low-dose metformin (500 mg/day) treatment group. Drugs were administered for 12 weeks. Systolic and diastolic blood pressure, heart rate, body mass index, triglyceride (TG), HDL and LDL-cholesterol, fasting plasma glucose (FPG), fasting plasma insulin (IRI), postprandial glucose, and HOMA-IR in the 75gOGTT, HbA1c, high-sensitivity CRP (hs-CRP) determined by cervical artery echography, and pulse wave velocity (PWV) were measured before/after 12-week drug administration. Significant decreases in HbA1c and HOMA-IR were noted in the pioglitazone group, along with significant decreases in TG, AST, ALT, blood pressure, hs-CRP and PWV. Significant decreases in HbA1c, HOMA-IR, BMI and waist circumference were noted in the metformin group. The pioglitazone group significantly improved the values for ALT, systolic blood pressure, hs-CRP and PWV compared to the metformin group. However, the metformin group demonstrated significant improvement in BMI compared with the pioglitazone group. Using a low dose regimen, pioglitazone significantly improved blood pressure and hepatic function and may be more effective than metformin to reduce risk factors in Japanese diabetic patients with metabolic syndrome at preventing atherosclerosis.

Controlled trial of nursing interventions to improve health outcomes of older African American women with type 2 diabetes.

Type 2 diabetes affects one in five African American women older than 60 years. These women face distinct challenges in managing diabetes self-care. Therefore, tailored self-care interventions for this population need to be developed and tested. The effectiveness of a tailored, four-visit, in-home symptom-focused diabetes intervention with and without booster telephone calls was compared with an attentional control focused on skills training for weight management and diet. African American women (n = 180; >55 years old, Type 2 diabetes mellitus >1 year, HbA1c >7%) were randomly assigned to the intervention or attentional control condition. Half the intervention participants were assigned to also receive a telephone-delivered booster intervention. Participants were evaluated at baseline and 3, 6, and 9 months. : Baseline HbA1 was 8.3 in the intervention group (n = 60), 8.29 in the intervention with booster group (n = 55), and 8.44 in the attentional control condition (n = 59). HbA1c declined significantly in the whole sample (0.57%) with no differences between study arms. Participants in the booster arm decreased HbA1c by 0.76%. Symptom distress, perceived quality of life, impact of diabetes, and self-care activities also improved significantly for the whole sample with no significant differences between study arms. Parsimonious interventions of four in-person visits yielded clinically significant decreases in HbA1c. Although the weight and diet program was intended as an attentional control, the positive effects suggest it met a need in this population. Because the contents of both the intervention and the attentional control were effective despite different approaches, a revised symptom-focused intervention that incorporates weight and diet skills training may offer even better results.

Sibutramine

Sibutramine

Effects of bed-time insulin versus pioglitazone on abdominal fat accumulation, inflammation and gene expression in adipose tissue in patients with type 2 diabetes

Aims/hypothesis Intra-abdominal fat (IAF) and inflammatory markers are correlated with cardio-vascular risk. We compared the impact of bed-time insulin versus pioglitazone treatment on these parameters in type 2 diabetic (T2D) patients. Methods Twenty-eight T2D patients poorly controlled with metformin and sulfonylurea were randomized to receive add-on therapy with pioglitazone or bed-time NPH insulin. IAF and subcutaneous fat (SCF) content, systemic low-grade inflammation level and expression of inflammation related genes in SCF, were measured before and after 24 weeks of treatment. Results Insulin and pioglitazone resulted in a significant decrease in HbA1c (−1.6% and −1.2%, respectively) and a significant increase in total body fat mass (1 ± 2.3 and 3.3 ± 2.7 kg, respectively). There was no change in IAF content after both treatments whereas significant increase in SCF content was only seen after pioglitazone treatment ( p < 0.05 versus insulin). hsCRP level decreased after pioglitazone and ferritin level decreased after insulin treatment. No change in mRNA expression of inflammation related genes was found after either treatment. Conclusion/interpretation This suggests that a 24-week treatment with pioglitazone or bed-time insulin has a similar impact on intra-abdominal fat mass and systemic low-grade inflammation.

Change in Hemoglobin A1cand C-Reactive Protein Levels in Patients With Diabetes Mellitus

The authors studied the effects on C-reactive protein (CRP) levels of an intensive intervention to reduce hemoglobin A1c (HbA1c) among 58 veterans with type 2 diabetes. Weekly group sessions of behavioral and pharmacologic intervention were conducted for 4 weeks at Providence Veterans Affairs Medical Center. Change in cardiovascular risk factors and CRP levels were compared at baseline and 3 months postintervention. There was a significant decrease in HbA1c (−0.7%±1.9%, P<.01), total cholesterol (−20.3±41.1 mg/dL, P=.01), low-density lipoprotein cholesterol (−11.7±31.4 mg/dL, P=.05), systolic blood pressure (−6.9±21.2 mm Hg, P=.03), and diastolic blood pressure (−6.0±10.6 mm Hg, P<.01) over 4 months. There was no significant change in CRP levels (1.1±6.6 mg/L, P=.2). These results suggest that CRP effects may not be adequate to predict changes in cardiovascular risk among diabetic patients and should not be a surrogate for achieving evidence-based goals in traditional cardiovascular risk factors.

Implementation, Outcomes, and Lessons Learned From a Collaborative Primary Health Care Program to Improve Diabetes Care Among Urban Latino Populations

A collaborative primary health care service demonstration program was conducted to improve diabetes care among limited English-proficient (LEP) Latino patients. The intervention provided a multilevel approach aimed at patients and health care providers: Community health workers (CHWs) were mobilized to offer diabetes education in Spanish to LEP Latino diabetes patients, and health professions students and providers were offered intensive Spanish language training and cultural competency workshops. Positive outcomes for patients included a significant decrease in HbA1c. Health care providers reported improved patient communication and greater appreciation for cultural influences on health. Collaborating institutions realized ongoing benefits from expansion of CHWs' role and incorporation of cultural and language classes into health professions students' and house officers' training programs. Lessons learned included the importance of working together at every stage to identify and provide for the CHWs' training and support needs and to link the program's intervention with evaluation of multilevel outcomes.

The clinical investigation of citrullus colocynthis (L.) schrad fruit in treatment of Type II diabetic patients: a randomized, double blind, placebo‐controlled clinical trial

Citrullus colocynthis (L.) Schrad fruit is an herbal medicine used by traditional herbalists for the treatment of diabetes in Iran. To determine its efficacy and toxicity, a 2 month clinical trial was conducted in 50 type II diabetic patients. Two groups of 25 each under standard antidiabetic therapy, received 100 mg C. colocynthis fruit capsules or placebos three times a day, respectively. The patients were visited monthly and glycosylated hemoglobin (HbA1c), fasting blood glucose, total cholesterol, LDL, HDL, triglyceride, aspartate transaminase, alanine transaminase, alkaline phosphatase, urea and creatinine levels were determined at the beginning and after 2 months. The results showed a significant decrease in HbA1c and fasting blood glucose levels in C. colocynthis treated patients. Other serological parameters levels in both the groups did not change significantly. No notable gastrointestinal side effect was observed in either group. In conclusion, C. colocynthis fruit treatment had a beneficial effect on improving the glycemic profile without severe adverse effects in type II diabetic patients. Further clinical studies are recommended to evaluate the long-term efficacy and toxicity of C. colocynthis in diabetic patients.

Metabolic effect of repaglinide or acarbose when added to a double oral antidiabetic treatment with sulphonylureas and metformin: a double-blind, cross-over, clinical trial

ABSTRACTObjective: To compare the metabolic effects of acarbose and repaglinide in type 2 diabetic patients who are being treated with a sulphonylurea–metformin combination therapy. The primary endpoint of the study was to evaluate which add-on treatment between acarbose and repaglinide is more efficacious in reducing PPG. The second endpoint was to evaluate which of these two treatment is more efficacious in the global management of glucose homeostasis in the enrolled patients.Research design and methods: After a 4-week run-in period with a suplonylurea–metformin combination, 103 patients were randomised to receive in addition either repaglinide, up to 6 mg/day (2 mg three times a day) or acarbose, up to 300 mg/day (100 mg three times a day) with forced titration (independently of their glycaemic control, unless side-effects developed due to the drug dosage) for 15 weeks. The treatment was then crossed-over for further 12 weeks until the 27th week. We assessed body mass index (BMI), glycosylated haemoglobin (HbA1c), fasting plasma glucoe (FPG), postprandial plasma glucose (PPG), fasting plasma insulin (FPI), postprandial plasma insulin (PPI), homeostatic model assesssment (HOMA) index, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (Tg), at baseline and at 1, 2, 15 and 27 weeks of treatment.Results: Seven patients did not complete the study, comprising one patient who was lost to follow-up and a further six through side-effects (two in week 1, one in week 15 and three after cross-over) Side-effects were classified as nausea (one in acarbose group), gastrointestinal events (four in acarbose group), and hypoglycaemia (one in repaglinide group). After 15 weeks of therapy, the repaglinide-treated patients experienced a significant decrease in HbA1c (−1.1%, p < 0.05), FPG (−9.5%, p < 0.05), and PPG (−14.9%, p < 0.05), when compared to the baseline values. However, the same treatment was associated with a significant increase in body weight (+2.3%, p < 0.05), BMI (+3.3%, p < 0.05) and FPI (+22.5%, p < 0.05); The increase was reversed during the cross-over phase. After 15 weeks of therapy, the acarbose-treated patients experienced a significant decrease in body weight (−1.9%, p < 0.05), BMI (−4.1%, p < 0.05), HbA1c (−1.4%, p < 0.05), FPG (−10.7%, p < 0.05), PPG (−16.2%, p < 0.05), FPI (−16.1%, p < 0.05), PPI (−26.9%, p < 0.05), HOMA index (−30.1%, p < 0.05), when compared to the baseline values. All these changes were reversed during the cross-over study phase, except those relating to HbA1c, FPG and PPG. The only changes that significantly differed when directly comparing acarbose- and repaglinide-treated patients were those relating to FPI (−16.1% vs. +22.5%, respectively, p < 0.05) and HOMA index (−30.1% vs. +2.7%, p < 0.05).Conclusion: In addition from having a similar effect to repaglinide on PPG, acarbose appeared to have a more comprehensive positive effect on glucose metabolism compared to repaglinide in this relatively small sample of type 2 diabetic patients when used as add-on therapy to sulphonylureas and metformin.

Long-term treatment of acromegalic patients resistant to somatostatin analogues with the GH receptor antagonist pegvisomant: its efficacy in relation to gender and previous radiotherapy

Pegvisomant is an effective treatment for somatostatin analogue-resistant acromegaly, but the determinants defining the response to this treatment are largely unknown. To investigate the efficacy of pegvisomant treatment in resistant acromegalic patients (e.g. serum IGF1 at least 1.25 x upper normal limit) in a clinical setting and the factors conditioning this response. A retrospective cross-sectional study performed in six Spanish University hospitals from 2004 to 2007. Patients Forty-four acromegalic patients (61.4% female, mean age: 49+/-14), 95% of whom had undergone pituitary surgery and 61% having received pituitary radiotherapy. The mean follow-up was 22.7+/-11.2 months. Main outcome measures IGF1 levels reflected treatment efficacy, and the influence of gender, age, weight, previous radiotherapy and duration of treatment was assessed. IGF1 normalisation was achieved in 84% of the patients. Male gender (P<0.05), previous irradiation (P<0.05) and the treatment duration (r=0.364, P<0.02) were associated with a better response to pegvisomant therapy. There was a significant decrease in HbA1c (P<0.001) and in the mean insulin dose (P<0.01) in acromegalic diabetic patients. Although 25% of patients experienced mild adverse events, pegvisomant was only withdrawn in four patients due to side effects (two cases of tumour growth, one liver dysfunction and one headache). Long-term pegvisomant is a very effective therapy in resistant acromegaly. Male gender and prior radiotherapy influence the therapeutic response rate.

Sibutramine effect on metabolic control of obese patients with type 2 diabetes mellitus treated with pioglitazone

Thiazolidinediones are supposed to be the pharmacologic agents that more physiologically fight the insulin resistance, but a possible adverse effect may be a weight increase. The aim of the study was to test the efficacy and tolerability of sibutramine on the metabolic effect of pioglitazone in obese patients with type 2 diabetes mellitus. All enrolled patients were required to have been diagnosed as being diabetic for at least 6 months and did not have glycemic control with diet and oral hypoglycemic agents such as sulfonylureas or metformin, both to the maximum tolerated dose. After a run-in period in which the eligible patients took a fixed dose of pioglitazone (30 mg/d), the patients were randomized to receive also sibutramine (10 mg/d) or placebo for 6 months. We assessed body mass index, hemoglobin A 1c (HbA 1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), fasting plasma insulin (FPI), postprandial plasma insulin (PPI), lipid profile, lipoprotein parameters, and lipoprotein (a) at baseline and after 3 and 6 months. No body mass index change was observed after 3 and 6 months in the pioglitazone + placebo (pp) group. Significant decrease was present in the pioglitazone + sibutramine (ps) group after 3 ( P < .05) and 6 months ( P < .01) compared with the baseline values, and this variation was significant ( P < .05) between groups. A significant HbA 1c decrease was observed after 3 ( P < .05) and 6 months ( P < .01) in both groups with respect to the baseline values. There was no difference in HbA 1c value between the 2 groups. No FPG, PPG, FPI, PPI, and homeostasis model assessment index change was observed at 3 months, whereas a significant decrease was present after 6 months ( P < .05), in both groups with respect to the baseline values. There was no difference in FPG, PPG, FPI, PPI, and homeostasis model assessment index value between the pp and ps groups. No significant low-density lipoprotein cholesterol change was observed at 3 months, whereas a significant decrease was present after 6 months ( P < .05), in both groups with respect to the baseline values. There was no difference in low-density lipoprotein cholesterol value between the pp and ps groups. No triglyceride variation was present at 3 and 6 months in the pp group and at 3 months in the ps group, whereas a significant decrease was observed at 6 months ( P < .05) in the ps group with respect to the baseline values. There was no difference in triglyceride value between both groups. No high-density lipoprotein cholesterol, apolipoprotein A-I, apolipoprotein B, and lipoprotein (a) changes were present in both groups with respect to the baseline values. Sibutramine appears to be a tolerable and efficacious drug when added to pioglitazone for the global management of obese diabetic patients.

Effect of Zinc Sulfate Supplementation on Lipid and Glucose in Type 2 Diabetic Patients

Type 2 diabetes mellitus is a chronic, progressive illness that causes considerable morbidity and premature mortality. More people are still having tendency to use herbal or alternative remedies. Zinc is a trace mineral which may be effective in diabetic patients. We evaluated the effect of zinc sulfate on biochemical markers of type 2 diabetic patients. In a randomized, controlled trial on diabetic subjects, forty patients received randomly either 660mg zinc sulfate or placebo for six weeks. Body Mass Index, Blood Pressure, Fasting Blood Sugar, 2-h postprandial glucose, Glycated hemoglobin, Triglyceride, cholesterol, low - density lipoproteins, high - density lipoproteins were checked before and six weeks after beginning of the study. HbA1C, BMI and Blood Pressure were measured after 12 weeks to evaluate the long term effect of drugs. The mean age of patients was 52.67±8.60. level of FBS, 2HPP, HbA1C decreased after six week treatment with zinc sulfate but it was not statistically significant. Due to zinc sulfate administration, significant decrease occurred in TG (P=0.005), chol (p=0.02), LDL (0.01) and systolic blood pressure (p=0.02). HDL was increased but it was not significant. No statistically significant differences were found prior to and after zinc treatment in BMI and diastolic blood pressure. After 12 weeks, there was a significant decrease in HbA1C (P=0.04) with zinc sulfate consumption. Zinc sulfate consumption in addition to other nutritional and pharmacological treatments in type 2 diabetic patients could be effective in lipid profile.

Effect of a Spanish Diabetes Education on Dietary Changes and Diabetes Control

O: To assess the impact of culturally appropriate and language‐sensitive diabetes education on diabetes control in a Hispanic diabetic cohort.M: Twenty six subjects (13 M &amp; 13 F), ranging from 29–75 years, participated in a 3‐month study. Subjects were enrolled from San Bernardino and Riverside counties. Waist and hip circumferences were measured. The Kolmogorov‐Smirnov Test was used for normality and the Paired Samples T‐test to compare baseline and three‐month means. Spearman's correlation coefficient was used to determine the linear relationship between laboratory results and dietary changes (Southwestern FFQ).R: The group had a baseline fasting blood glucose mean of 158 mg/dL, a baseline HbA1c mean of 8.5%, and insulin mean of 14.7 uU/mL. There was a significant decrease in HbA1c % (8.5% ± 2.3 vs. 7.6%±1.6 p=.007) in both genders. There was a significant decrease in hip circumference (cm) (107.2±14 vs. 105.8±13 p=.044). Though not significant, there was also a decrease in FBG (158±83 vs. 152±77, p=0.558). There were significant correlations, at 3 months, between scale weight (kg) and dietary cholesterol (mg) (r=.456, p=.019), BMI (kg/m2) and dietary cholesterol (r=.404, p=.041), BMI and % calories from saturated fat (r=.424, p=.031), insulin (uU/mL) and supplement chromium use (r= −.451, p=.021).C: The program had a beneficial effect on dietary changes and blood sugar control.

Effect of Glyburide—Metformin Combination Tablet in Patients with Type 2 Diabetes

To evaluate the efficacy and safety of glyburide/metformin combined tablet compared to glyburide or metformin alone in patients with type 2 diabetes. In this 16-week, multicenter, randomized, double-blind, 4-arm and parallel clinical trial study, 100 patients with type 2 diabetes mellitus were recruited and 76 patients were available for statistical analysis at the end of the study. After 1 week of placebo washout period, eligible patients were randomly assigned into 1 of 4 treatment groups: glyburide 5 mg b.i.d.; metformin 500 mg b.i.d.; glyburide/metformin 2.5 mg/500 mg b.i.d.; or glyburide/metformin 5.0 mg/500 mg b.i.d. The doses were titrated every 2 weeks to a maximum of 4 tablets per day if the patients fasting plasma glucose (FPG) still exceeded 140 mg/dL. Efficacy was evaluated by the changes from baseline in glycosylated hemoglobin (HbA1c) and FPG at week 16. Adverse events were recorded and summarized by treatment group. At week 16, patients who received glyburide/metformin 2.5 mg/500 mg or 5.0 mg/500 mg tablets had greater reductions in FPG (all p<0.001) compared with glyburide or metformin monotherapy. Patients who took glyburide/ metformin 2.5 mg/500 mg tablet and glyburide/metformin 5.0 mg/500 mg tablet had significant decreases in HbA1c (both p<0.0125). Furthermore, treatment with glyburide/metformin 2.5 mg/500 mg resulted in significantly greater reduction in HbA1c compared to glyburide or metformin (-1.77%, p<0.001 and -1.34%, p=0.002), and treatment with glyburide/metformin 5.0 mg/500 mg resulted in significant lowering of HbA1c compared to glyburide or metformin alone (-1.73%, p<0.001 and -1.30%, p=0.005). Both the glyburide/metformin 2.5 mg/500 mg and glyburide/metformin 5.0 mg/500 mg combination therapy groups experienced fewer gastrointestinal adverse events than the metformin monotherapy group. Both glyburide/metformin 2.5 mg/500 mg and glyburide/metformin 5.0 mg/500 mg combination therapy were efficacious and well tolerated in the treatment of Chinese patients with type 2 diabetes mellitus.

Weight No More: a randomised controlled trial for people with type 2 diabetes on insulin therapy

AbstractThis study investigated whether a newly developed, dietitian led, weight management programme ‘Weight No More’ was effective at helping patients with type 2 diabetes, who are established on insulin therapy, to lose weight in both the short and long term.Forty‐nine patients were recruited to this randomised controlled trial using convenience volunteer sampling. Patients were randomised into either a control group (n = 20) or an intervention group (n = 29). The intervention group underwent the Weight No More programme consisting of eight 11/2 hour group teaching sessions. The control group received their standard diabetes care of an appointment with the dietitian on an annual basis.Measurements of outcome variables were taken at baseline, four months (end of intervention), six months and 12 months post‐intervention. At four months the intervention group saw a significant decrease in weight of 2.2kg (p&lt;0.01) and in HbA1c of 0.9% (p&lt;0.01), and insulin use reduction of 10.1 units (p&lt;0.01). The control group also had a significant decrease in HbA1c of 0.3% (p&lt;0.01), although this was less than the intervention group; no other significant changes were seen. At six and 12 months post‐intervention there were no significant differences when compared to baseline measurements in either group.The Weight No More programme is an effective short‐term treatment option for overweight patients with diabetes. However, when compared to standard care, the beneficial effects of the programme are lost after six months and 12 months follow up. Further research is required to establish weight maintenance strategies and cost effectiveness. Copyright © 2007 John Wiley &amp; Sons.

Effects of Icodextrin on Glycemic and Lipid Profiles in Diabetic Patients Undergoing Peritoneal Dialysis

Aim: Icodextrin reduces glucose absorption from the peritoneal dialysate. We conducted this prospective, open-labeled, multicenter study to determine the effects of icodextrin on glycemic and lipid parameters in diabetic patients undergoing continuous ambulatory peritoneal dialysis (PD) or automated PD. Methods: Patients were recruited from 15 institutions in Japan, and a total of 51 patients (15 women and 36 men, mean age: 59 ± 10 years, median duration of PD: 13 months) were enrolled. The patients were administered an overnight or daytime dwell of 1.5 or 2.0 l of 7.5% icodextrin-containing solution. At baseline and 3, 6, 9 and 12 months after the start of icodextrin, nonfasting blood was drawn for measurement of glycated hemoglobin (HbA1C) and serum lipids. Results: During icodextrin treatment, there was no change in overall HbA1C levels compared to baseline values; however, for those with baseline HbA1C ≧6.5% (n = 22), significant decreases in HbA1C were observed. Mean total/LDL cholesterol and triglycerides were decreased significantly during icodextrin treatment, with greater decreases for patients with baseline total cholesterol ≧220 mg/dl, LDL cholesterol ≧120 mg/dl or triglycerides ≧150 mg/dl. HDL cholesterol did not differ at any time point; however, values for patients with baseline HDL cholesterol <40 mg/dl tended to increase with marginal significance. Conclusions: In the current study, switching from glucose-containing dialysis solution to icodextrin resulted in improved lipid profiles and possibly a favorable metabolic profile, particularly in patients with poor glycemic control. These hypotheses remain to be proven in controlled clinical trials.

１型糖尿病患者におけるインスリングラルギンの血糖改善効果と低血糖発現頻度の検討

To evaluate the effects of switching from NPH insulin(twice daily)to insulin glargine on blood glucose control(HbA1C),insulin dosage and frequency of hypoglycemia in Japanese patients with type 1 diabetes,we monitored these parameters in 37 type 1 diabetics for 12 months after switching.The patients were assigned to 3 groups according to HbA1C at switching :good(<7.0%),fair(7.0-7.9%)and poor(≥8.0%).Though there was no improvement in HbA1C in the good and fair groups over the 12 months,there was a significant decrease in HbA1C in the poor group(10.2±1.2%→9.2±1.2%,p<0.01).Over this period,total dosage and basal dosage significantly decreased as compared to the time of switching.In the good and poor control groups,there was a significant decrease in the frequency of hypoglycemia.In conclusion,insuling largine improves glycemic control in patients with type 1 diabetes mellitus,especially in patients with poor blood glucose control.

Metabolic Control of Adults With Type 2 Diabetes Mellitus Through Education and Counseling

To test the efficacy of a controlled nursing intervention focused on education and counseling to improve metabolic control of adults diagnosed with diabetes mellitus type 2 in (DMT2) ambulatory care. A quasi-experimental design with repeated measures was selected. A sample of 45 subjects participated, of which 25 were in the experimental group, and 20 in the comparison group. Measures were taken at 0, 3, 6, 9, and 12 months, including glycosylated hemoglobin (HbAlc), psychosocial, and clinical variables. Results showed a significant decrease in HbAlc in the experimental group, as well as positive effects of self-care agency, adaptation, and barriers to treatment (plus one interaction) on the HbA1c levels and on the scores of self-care actions. The counseling and educational model applied in the intervention was effective to improve the metabolic control of diabetic patients in the experimental group. Self-care agency, adaptation, and barriers were predictors of self-care measures and level of HbA1c.

The effects of home monitoring by public health nurse on individuals' diabetes control

Diabetes is an important health problem that changes the lifestyle of individuals. The ability of individuals to control their disease is directly related to their adaptation to the disease and self-care. The purpose of this study was to determine the effect of home monitoring of individuals with diabetes for the purpose of developing their self-care and their adaptation to diabetes. The research used a quasi-experimental (time series) design study. A convenient sample of 34 patients receiving outpatient diabetes care at Hacettepe University Adult Hospital Endocrinology Clinic participated in the study on a voluntary basis. After being seen for the first time in the clinic, they were followed up for a 6-month period in their homes. At the end of the home monitoring period, these patients with diabetes had a statistically significant decrease in HbA 1c (glycated hemoglobin; p = .000), fasting blood glucose ( p = .001), postmeal blood glucose ( p = .000), and systolic blood pressure ( p = .007) measurements. Diabetes is a quite frequently seen chronic and progressive disease. Nursing monitoring is important to develop an individual's skills in self-care and to support compliance to diabetes. This study supports the finding that the home monitoring of individuals with diabetes by community health nurse improves diabetic control. It is recommended that individuals with diabetes be monitored not only in the hospital but also in their homes for a comprehensive evaluation.

The effects of insulin glargine treatment and an educational programme on glycaemic control in type 2 diabetes patients in clinical practice

ABSTRACTObjective: This retrospective analysis was performed to establish the effect of initiating insulin glargine (LANTUS; sanofi-aventis, Paris, France), a once-daily basal insulin analogue, in combination with an educational programme on glycaemic control and body weight in sub-optimally controlled patients with Type 2 diabetes in clinical practice.Research design and methods: We undertook a retrospective review of the medical records of 46 patients (mean age 61.5 ± 8.6 years) with Type 2 diabetes. These patients had previously been treated with oral antidiabetic agents (OADs; n = 18) or insulin only (n = 28) and had then received insulin glargine in combination with OADs or prandial insulin, for 30 months. Records of metabolic control and body weight data were analysed at 9 and 30 months. Patients had taken part in a diabetes educational programme before initiation of insulin glargine and received continued physician consultations throughout.Results: Following initiation of insulin glargine, patients showed a significant decrease in HbA1c from 8.14 ± 1.7% to 7.18 ± 0.9% at 30 months ( p < 0.001). When the results were analysed by pre-treatment, patients pre-treated with OADs showed a reduction in HbA1c of 2.3% at 30 months ( p < 0.001), while patients pre-treated with insulin only showed a decrease in HbA1c of 0.4% ( p < 0.005). There was no significant change in body weight. No unexpected adverse events or episodes of severe hypoglycaemia (blood glucose < 40 mg/dL [< 2.2 mmol/L]) occurred.Conclusions: Insulin glargine in combination with educational support and close clinical supervision significantly improved metabolic control without significant weight change in patients with Type 2 diabetes in clinical practice over 30 months. Additional studies are required to establish if similar results can be obtained in a larger cohort of patients.

The efficacy ofSilybum marianum (L.) Gaertn. (silymarin) in the treatment of type II diabetes: a randomized, double-blind, placebo-controlled, clinical trial

Oxidative stresses are increasingly implicated in the pathogenesis of diabetic complications which may either cause direct pancreatic beta-cell damage or lead to metabolic abnormalities that can induce or aggravate diabetes. The valuable effect of antioxidant nutrients on the glycemic control of diabetic patients has been reported in experimental and clinical studies. The present study was designed to investigate the effects of the herbal medicine, Silybum marianum seed extract (silymarin), which is known to have antioxidant properties on the glycemic profile in diabetic patients. A 4-month randomized double-blind clinical trial was conducted in 51 type II diabetic patients in two well-matched groups. The first group (n = 25) received a silymarin (200 mg) tablet 3 times a day plus conventional therapy. The second group (n = 26) received the same therapy but a placebo tablet instead of silymarin. The patients were visited monthly and glycosylated hemoglobin (HbA(1)c), fasting blood glucose (FBS), insulin, total cholesterol, LDL and HDL, triglyceride, SGOT and SGPT levels were determined at the beginning and the end of the study. The results showed a significant decrease in HbA(1)c, FBS, total cholesterol, LDL, triglyceride SGOT and SGPT levels in silymarin treated patients compared with placebo as well as with values at the beginning of the study in each group. In conclusion, silymarin treatment in type II diabetic patients for 4 months has a beneficial effect on improving the glycemic profile.