Significant Decrease In HbA1c Research Articles

An Effective Intervention for Diabetic Lipohypertrophy: Results of a Randomized, Controlled, Prospective Multicenter Study in France.

Background: Lipohypertrophy (LH) is highly prevalent and is potentially harmful to insulin-injecting patients.Methods: In this study, we assessed the impact of injection technique (IT) education, including use of a 4-mm pen needle on insulin-treated patients with clinically observed LH in a randomized, controlled, prospective multicenter study in France with follow-up of 6 months. Intensive education and between-visit reinforcement were given to the intervention group. Control patients received similar messages at study outset.Results: A total of 123 patients were recruited (age 52.1 ± 15.7 years; men 70.7%; body mass index >30 kg/m2: 34.2%; type 1: 53.7%; years with diabetes mellitus: 18.1 ± 10.5), of which 109 patients were included in the final analysis. The intervention group (n = 53) showed a significant decrease of total daily dose of insulin (average at baseline: 54.1 IU) at 3 months (T-3) and 6 months (T-6), reaching just over 5 IU versus baseline (P = 0.035). Corresponding, although not significant, decreases occurred in controls (n = 56); between-group differences were not significant. There were significant decreases in HbA1c (up to 0.5%) at T-3 and T-6 in both groups, with no significant differences between groups. A significant number of intervention patients improved their IT habits; about half achieved ideal IT habits by T-3 versus a quarter of control patients. By T-6, 2/3 of intervention patients achieved either ideal or acceptable IT habits, while only 1/3 of control patients did.Conclusions: Our intervention was effective in both study arms, however, to a greater degree and more rapidly in the intervention group. Widespread application of this intervention could be highly cost-effective.

Safety and Efficacy of The Available Oral Anti diabetic Drugs In Treating Type II Diabetics During Ramadan Fasting In Sohag Governorate.

Objective: to assess safety and efficacy of the available oral anti diabetic Drugs during Ramadan 2016 in Sohag Governorate . Methodology: This study was conducted on 90 type II Diabetic patients attending to outpatient Endocrinology clinic in Sohag University Hospital, on oral treatment classified into 5groups,as following , 20 (22.22%)patients on Metformin(Group I),30 (33.33%)patients on Sulphonylureas with or without metformin(Group II), 18 (20%) patients on Dipeptidyl peptidase-4 inhibitors with or without metformin (Group III),12 (13.33% ) patients on Thiazolidinedoines with or without metformin (Group V),10 (10%) patients on combinations of more than two drugs (Group VI), Mean age of patients is 59.93±7.87years, (61.11%)of them were females,(38.89%) of them were male patients and Mean duration of diabetes is 4.52±2.45(range 1:10).follow up of the patient was done by Wight changes, measuring blood sugar ,asses Hba1c ,and renal function also was done before and during ramadan. Results: In this study we found a significant decrease in Hba1c after Ramadan with Group III (DPP4I) compared with other Groups also we found the number of hypoglycemic episodes of all groups about 10 (11.11%), more with Group II (SUs) about (9) patients developed hypoglycemia of whom 30, compared with other groups while lower number of hypoglycemia was found with Group III (DPP4I),about one patient developed hypoglycemia, also we found the number of non fasted days more with SUs,(range 2-10) also we found no body weight changes more with Group III (DPP4I) while body weight gain occurred with Group II (SUs) about 1-4Kgs . In conclusion, Ramadan represents one of challenging issues for health care providaers all over the world . DPP4 inhibitors may considered favorable for use during and after Ramadan due to their lower rate of hypoglycemic events and weight neutral/loss effect during and after Ramadan .

The effect of 12 weeks carnosine supplementation on renal functional integrity and oxidative stress in pediatric patients with diabetic nephropathy: a randomized placebo-controlled trial.

Oxidative stress is a significant contributor to the pathogenesis of diabetic nephropathy. Carnosine is a natural radical oxygen species scavenger. We investigated the effect of carnosine as an adjuvant therapy on urinary albumin excretion (UAE), the tubular damage marker alpha 1-microglobulin (A1M), and oxidative stress in pediatric patients with type 1 diabetes and nephropathy. This randomized placebo-controlled trial included 90 patients with diabetic nephropathy, despite oral angiotensin-converting enzyme inhibitors (ACE-Is), who were randomly assigned to receive either 12 weeks of carnosine 1 g/day (n = 45), or matching placebo (n = 45). Both groups were followed-up with assessment of hemoglobin A1c (HbA1c), UAE, A1M, total antioxidant capacity (TAC) and malondialdhyde (MDA). Baseline clinical and laboratory parameters were consistent between carnosine and placebo groups (P > .05). After 12 weeks, carnosine treatment resulted in significant decrease of HbA1c (8.2 ± 2.1% vs 7.4 ± 1.3%), UAE (91.7 vs 38.5 mg/g creatinine), A1M (16.5 ± 6.8 mg/L vs 9.3 ± 6.6 mg/L), MDA levels (25.5 ± 8.1 vs 18.2 ± 7.7 nmol/mL) while TAC levels were increased compared with baseline levels (P < .001) and compared with placebo (P < .001). No adverse reactions due to carnosine supplementation were reported. Baseline TAC was inversely correlated to HbA1c (r = -0.58, P = .04) and A1M (r = -0.682, P = .015) among carnosine group. Oral supplementation with L-Carnosine for 12 weeks resulted in a significant improvement of oxidative stress, glycemic control and renal function. Thus, carnosine could be a safe and effective strategy for treatment of pediatric patients with diabetic nephropathy.

Efficacy of an education course delivered to community health workers in diabetes control: A randomized clinical trial.

Community health workers are community members who provide education and care for patients for a broad range of health issues, including diabetes mellitus. However, few community health workers are trained for diabetes education and little is known about the effectiveness of their interventions. The aim of this study is to evaluate the effect of a diabetes education program delivered to community health workers in improving the metabolic control of patients with type 2 diabetes mellitus. Eight community health workers, providing care for 118 patients, were randomized in two groups to receive a 1-month diabetes education program (intervention, patients n = 62) or an education course in other health issues (control, patients n = 56). Each community health worker was responsible for transmitting the acquired knowledge to patients. Primary outcome was changed in HbA1C 3 months after the intervention. PARTICIPANTS: Mean age was 61 ± 11 years, 35% were men and 62% were whites. HbA1c levels reduced in both groups (intervention: 9.1 ± 2.2 vs. 7.9 ± 1.9%; control: 9.1 ± 2.1 vs. 8.4 ± 2.5%, p < 0.001), but no statistically significant differences were observed between groups (p between groups = 0.13). Total cholesterol (intervention: 192 ± 43 vs. 182 ± 39 mg/dl; control: 197 ± 44 vs. 191 ± 45 mg/dl, p between groups = 0.035) and triglycerides (intervention: 158 [106-218] vs. 135 [106-215]; control: 128 [100-215] mg/dl vs. 146 [102-203] mg/dl, p between groups = 0.03) reduced overtime only in intervention group. In this study, a significant decrease in HbA1c was observed during patients' follow-up, but it was similar in intervention and control groups. The diabetes mellitus education course delivered to community health workers was able to improve patients' lipid profile.

The Role of Sleeve Gastrectomy on Preventing Type 2 Diabetes Mellitus.

AIM:To investigate the effect of bariatric surgery on HbA1c and serum cortisol levels in morbidly obese patients without type 2 diabetes mellitus.MATERIALS AND METHODS:Twenty-nine patients who underwent sleeve gastrectomy and whose body mass index was> 40 were included in the present study. Patients’ files were reviewed retrospectively. Those with diabetes mellitus and those with age <18 were excluded from the study. Pre-operative and 1-year post operative data were documented. The obtained data were analysed by SPSS statistical program.RESULTS:The mean age of the patients was 27.4 ± 8.4. 5 of the patients were male, and 24 were female. The mean body mass index of the patients was 44 ± 2.3. 1 patient [3.4%] had hypertension. Four patients [13.7%] had gastroesophageal reflux disease. The number of smokers was 7 [24.1%], and the number of alcohol users was 3 [10.3%]. There was a statistically significant decrease in HbA1c, body mass index values after operation [p value <0.01], but cortisol was not different [p value = 0.72].CONCLUSION:In this present study we found that bariatric surgery caused a significant decrease in HbA1c levels in non-diabetic patients, suggesting that bariatric surgery may prevent Type 2 Diabetes Mellitus in obese patients.

Continuous subcutaneous insulin infusion (CSII) therapy at Derby Teaching Hospitals: sustained benefits in glucose control.

In the short term, continuous subcutaneous insulin infusion (CSII) has been associated with improved glycaemic control, reduced hypoglycaemia and improved quality of life (QOL). However, limited data are available on its long-term benefits, particularly in the UK. We aimed to assess the impact of CSII on longer term outcomes. Patient-level data were obtained for CSII users at Derby Teaching Hospitals, UK. Patient confidence and satisfaction questionnaires using the Likert scale were used to assess confidence in self-management. Comparative statistics were conducted using Pearson's chi-square and Student's t-tests. Some 258 CSII users were identified (60.1% female, mean age 43.9±13.4years). Overall, there was significant decrease in HbA1c from 78mmol/mol (9.3±2.0%) at baseline, to 69mmol/mol (8.5±1.3%) at 6months [mean difference (md): -0.64; 95% confidence interval (95% CI): -0.91 to -0.37; P<0.0001]; which was sustained at 6years of follow-up (HbA1c : 66mmol/mol, 8.2±1.3%; md: -1.07%; 95% CI: -1.45 to -0.69; P<0.0001). One hundred and twenty-one patients (47%) responded to the survey, of whom 95 (78.5%) reported a reduction in the frequency of hypoglycaemia; 102 (84.3%) were satisfied with the quality of care received in the insulin pump service. CSII therapy led to a sustained long-term improvement in glycaemic control in addition to a reduction in self-reported hypoglycaemia.

Effect of basic periodontal treatment on glycemic control and inflammation in patients with diabetes mellitus type 1 and type 2: controlled clinical trial

Compare the response of basic periodontal therapy in diabetes patients with diabetes type 1 and type 2. We selected 70 patients with periodontitis; these were divided into three groups: the control group (n = 11), systemically healthy patients; test group 1 (n = 14), patients with type 1 diabetes mellitus; test group 2 (n = 27), patients with type 2 diabetes mellitus. The groups received basic periodontal treatment after clinical examination. The analyses were performed at 0, 3 and 6 months; clinical parameters included the amount of periodontal and gingival crevicular fluid. Glycated hemoglobin (HbA1c) levels and prostaglandin E2 (PGE2) expression were measured. All clinical periodontal parameters evaluated improved in both groups, as did the amount of gingival crevicular fluid. A more significant decrease in HbA1c and PGE2 expression (p < 0.05) occurred in test group 1 after 6 months. The basic periodontal treatment was more effective for glycemic control in patients with type 1 diabetes mellitus.

Benefits of Islet Transplantation as an Alternative to Pancreas Transplantation: Retrospective Study of More Than 10 Ten Years of Experience in a Single Center.

Pancreas transplantation (PTx) represents the method of choice in type 1 diabetic patients with conservatively intractable hypoglycemia unawareness syndrome. In 2005, the Institute for Clinical and Experimental Medicine (IKEM) launched a program to investigate the safety potential of islet transplantation (ITx) in comparison to PTx. This study aims to compare the results of PTx and ITx regarding severe hypoglycemia elimination, metabolic control, and complication rate. We analyzed the results of 30 patients undergoing ITx and 49 patients treated with PTx. All patients were C-peptide-negative and suffered from hypoglycemia unawareness syndrome. Patients in the ITx group received a mean number of 12,349 (6,387-15,331) IEQ/kg/person administered percutaneously into the portal vein under local anesthesia and radiological control. The islet number was reached by 1-3 applications, as needed. In both groups, we evaluated glycated hemoglobin, insulin dose, fasting and stimulated C-peptide, frequency of severe hypoglycemia, and complications. We used the Mann Whitney test, Wilcoxon signed-rank test, and paired t-test for analysis. We also individually assessed the ITx outcomes for each patient according to recently suggested criteria established at the EPITA meeting in Igls. Most of the recipients showed a significant improvement in metabolic control one and two years after ITx, with a significant decrease in HbA1c, significant elevation of fasting and stimulated C-peptide, and a markedly significant reduction in insulin dose and the frequency of severe hypoglycemia. Seventeen percent of ITx recipients were temporarily insulin-independent. The results in the PTx group were comparable to those in the ITx group, with 73% graft survival and insulin independence in year 1, 68% 2 years and 55% 5 years after transplantation. There was a higher rate of complications related to the procedure in the PTx group. Severe hypoglycemia was eliminated in the majority of both ITx and PTx recipients. This report proves the successful initiation of pancreatic islet transplantation in a center with a well-established PTx program. ITx has been shown to be the method of choice for hypoglycemia unawareness syndrome, and may be considered for application in clinical practice if conservative options are exhausted.

Nonsurgical periodontal-therapy improves glycosylated hemoglobin levels in pre-diabetic patients with chronic periodontitis.

AIMTo evaluate the effect of nonsurgical periodontal therapy on glycosylated haemoglobin levels in pre-diabetic patients with chronic periodontitis (CHP).METHODSSixty pre-diabetic patients with CHP were selected and equally allocated to case and control group. All subjects were evaluated at base line for periodontal parameters (plaque index, oral hygiene index, modified gingival index, probing pocket depth, clinical attachment level) and systemic parameters [glycosylated hemoglobin (HbA1c), fasting lipid profile, and fasting blood glucose]. The case group received non-surgical periodontal therapy. Subjects were re-evaluated for periodontal and systemic parameters after three months.RESULTSBoth groups were comparable at baseline. Three months after non surgical periodontal therapy (NSPT), there was significant improvement in periodontal parameters in case group. The mean difference in systemic parameters like HbA1c and fasting plasma glucose from baseline to fourth month for case group was 0.22 ± 0.11 and 3.90 ± 8.48 respectively and control group was -0.056 ± 0.10 and -1.66 ± 6.04 respectively, which was significant between case and control group (P < 0.05). In the case group there was a significant decrease in HbA1c from baseline to three months following NSPT (P < 0.05).CONCLUSIONThis study showed that periodontal inflammation could affect the glycemic control in otherwise systemically healthy individuals. Periodontal therapy improved periodontal health status and decreased glycosylated haemoglobin levels, thus reducing the probability of occurrence of inflammation induced prediabetes in patients with CHP.

Effectiveness of advanced carbohydrate counting in type 1 diabetes mellitus: a systematic review and meta-analysis.

Potential benefits of carbohydrate counting for glycemic control in patients with type 1 diabetes mellitus (T1DM) remain inconclusive. Our aim is to systematically assess the efficacy of carbohydrate counting in patients with T1DM. We searched PubMed, Embase, Web of Science, Cochrane Library and the Chinese Biology Medicine (CBM) up to December 2015. Randomized controlled trials (RCTs) with at least 3 months follow-up that evaluated carbohydrate counting compared with usual or other diabetes dietary education in patients with T1DM were included. Overall meta-analysis identified a significant decrease in HbA1c concentration with carbohydrate counting versus other diabetes diet method or usual diabetes dietary education (SMD: −0.35, 95%CI: −0.65 to −0.05, P = 0.023). Subgroup analysis restricted to trials which compared carbohydrate counting with usual diabetes dietary found a significant decrease in HbA1c in carbohydrate counting group (SMD: −0.68, 95%CI: −0.98 to −0.38, P = 0.000), and a similar result has emerged from six studies in adults (SMD: −0.40, 95%CI: −0.78 to −0.02, P = 0.037). Carbohydrate counting may confer positive impact on glucose control. Larger clinical trials are warranted to validate this positive impact.

Effect of Diabetea tea ™ consumption on inflammatory cytokines and metabolic biomarkers in type 2 diabetes patients

Ethnopharmacological relevanceDiabetea tea™ (DT) is an anti-diabetic alternative medicine in some Asian countries. The main constituent of DT is black tea originating from Camellia sinensis that is supplemented by 12 other medicinal plants. Black tea contains a large amount of the flavonoids catechins especially epigallocatechin gallate (EGCG) which has anti-inflammatory and antioxidative capacity. This study was undertaken to evaluate the possible effects of DT intake on inflammatory cytokines, regulatory T cells (Tregs) and metabolic biomarkers in T2DM. Materials and methodsThe study included 50 patients with T2DM. The patients had received 3 cups (600ml) of DT extract or placebo (PL) extract per day during a period of 12 weeks. Intracellular cytokine expression in peripheral blood mononuclear cell (PBMC) as well as the glycemic and lipid profiles were measured at baseline and after the treatment period. The active constituents of the medicinal plants included in DT were investigated by gas chromatography-mass spectrometry (GC/MS). ResultsIngestion of DT suppressed CD4+ T cell expression of IL-1β and Il-8 (p<0.05) and up-regulated the expression of IL-10 and the Treg/IL-17 ratio (p<0.05) which was not shown in PL. A significant decrease in HbA1c and LDL was observed at the end of the study period (p<0.05) in DT. The GC/MS analyses of DT indicated the presence of lupeol, β-Amyrin and β-sitosterol. Also analyses of individual herbs showed the presence of higher levels of lupeol and β-Amyrin in Nuga Ficus bengalensis and β-sitosterol in the Attikka Ficus racemosa, indicating that the active ingredients of DT are concentrated in these two herbs. ConclusionThe present study provides evidence that DT has hypoglycemic and antihyperlipidemic properties. Interestingly, DT has anti-inflammatory effects. These properties are attributed to the flavonoids, triterpenes and phytosterol contents of the tea. We suggest that DT protects against diabetes complications in the long term.

Effect of Chinese Herbal Medicine Jinlida Granule in Treatment of Patients with Impaired Glucose Tolerance

Background:Diabetes mellitus (DM) remains a major health problem worldwide. Several clinical trials have shown the superiority of the Traditional Chinese Medicine in delaying or reversing the development and progression of DM. This study aimed to evaluate the efficacy of Jinlida (JLD) granule, a Chinese herbal recipe, in the treatment of impaired glucose tolerance (IGT) and its effect on the prevention of DM.Methods:Sixty-five IGT patients were randomized to receive one bag of JLD granules three times daily (JLD group, n = 34) or no drug intervention (control group, n = 31) for 12 weeks. Oral glucose tolerance test, glycated hemoglobin A1c (HbA1c), body mass index, blood lipids levels, fasting insulin, and insulin resistance calculated using homeostatic model assessment (HOMA-IR) of all the patients were observed and compared before and after the treatment.Results:Sixty-one participants completed the trial (32 in JLD group and 29 in the control group). There were statistically significant decreases in HbA1c (P < 0.001), 2-h plasma glucose (P < 0.001), and HOMA-IR (P = 0.029) in JLD group compared with the control group after 12 weeks of treatment. After 12 weeks of treatment, two (6.9%) patients returned to normal blood glucose, and five (17.2%) patients turned into DM in control group, while in the JLD group, 14 (43.8%) returned to normal blood glucose and 2 (6.2%) turned into DM. There was a significant difference in the number of subjects who had normal glucose at the end of the study between two groups (P = 0.001).Conclusions:JLD granule effectively improved glucose control, increased the conversion of IGT to normal glucose, and improved the insulin resistance in patients with IGT. This Chinese herbal medicine may have a clinical value for IGT.

Primary Care Continuity Improves Diabetic Health Outcomes: From Free Clinics to Federally Qualified Health Centers.

There are a number of well-established barriers to accessing primary care. The LINKED Study set out to improve primary care usage through 1-on-1 counseling and referrals for patients with diabetes being treated at local free clinics. We hypothesized that this educational intervention paired with expedited referral would increase the use of federally qualified health centers (FQHCs) as a source of health care and ultimately lead to improved diabetic health. Medical student volunteers counseled participants on the importance of primary care. The participants then completed surveys about diabetic health, socioeconomic status, and general demographics. Participants were subsequently assigned to 1 of 2 FQHCs; designated care coordinators facilitated appointments. At the end of a 9-month action period, participants repeated the initial surveys, now including appointment history and health data (hemoglobin A1c (%) [HbA1c], body mass index). Sixty-eight participants were enrolled. The average time since a diagnosis of diabetes mellitus was 8.3 years (standard deviation [SD], 8.4 years), and 25% of participants used insulin. Mean baseline HbA1c for participants with a recorded value (n = 55) was 9.5 (SD, 2.5). FQHC appointments were scheduled by 68% of participants; 38% of the participants attended ≥2 appointments. The most common reported barriers to accessing primary care were no prior health insurance (85.3%) and cost of medical care (72.1%). In our follow-up assessment there was a statistically significant decrease in HbA1c for those linked to FQHCs (9.5 [SD, 2.3] to 8.3 [SD, 2.2]; n = 21). This study demonstrates the utility of a linkage program from free clinics to FQHCs. Those individuals with diabetes receiving health care from an FQHC demonstrated improved glycemic control.

The Calculating Boluses on Multiple Daily Injections (CBMDI) study: A randomized controlled trial on the effect on metabolic control of adding a bolus calculator to multiple daily injections in people with type 1 diabetes.

Although the insulin bolus calculator is increasingly being used by people with type 1 diabetes (T1D) on multiple daily injection (MDI) therapy, few studies have investigated its effects on glycemic control. The aim of this study was to determine whether adding this device to therapeutic intensification could further improve metabolic control. A 4-month randomized controlled clinical trial was performed comparing subjects undergoing therapeutic intensification and either using the bolus calculator (Cb group) or not (active control [Co] group). Metabolic control, fear of hypoglycemia, and treatment acceptance were evaluated. In all, 70 people completed the study (42 in the Cb group, 28 in the Co group). There was a significant decrease in HbA1c in both the Cb and Co groups (-7 mmol/mol [-0.7%] vs -4 mmol/mol [-0.4%], respectively). There were no significant differences in HbA1c at baseline or the end of the study, or in the decrease in HbA1c, glycemia, or changes in blood glucose levels at the end of the study between the two groups. There was a significant increase in the number of participants with good metabolic control (HbA1c <58 mmol/mol [7.5%]) in the Cb group (from 16.7% to 40.5%), but not in the Co group. The incidence of hypoglycemic events was reduced slightly but significantly only in the Cb group. There was no change in the fear of hypoglycemia at the end of the study. The bolus calculator was well accepted. In T1D, adding a bolus calculator to intensive MDI resulted in a significant improvement in metabolic control and slightly decreased the number of hypoglycemic episodes. Metabolic control also improved in the Co group.

Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes

ObjectiveTo investigate and compare the effects of Buddhist walking meditation and traditional walking on glycemic control and vascular function in patients with type 2 diabetes mellitus. MethodsTwenty three patients with type 2 diabetes (50–75 years) were randomly allocated into traditional walking exercise (WE; n=11) or Buddhism-based walking meditation exercise (WM; n=12). Both groups performed a 12-week exercise program that consisted of walking on the treadmill at exercise intensity of 50–70% maximum heart rate for 30min/session, 3 times/week. In the WM training program, the participants performed walking on the treadmill while concentrated on foot stepping by voiced “Budd” and “Dha” with each foot step that contacted the floor to practice mindfulness while walking. ResultsAfter 12 weeks, maximal oxygen consumption increased and fasting blood glucose level decreased significantly in both groups (p<0.05). Significant decrease in HbA1c and both systolic and diastolic blood pressure were observed only in the WM group. Flow-mediated dilatation increased significantly (p<0.05) in both exercise groups but arterial stiffness was improved only in the WM group. Blood cortisol level was reduced (p<0.05) only in the WM group. ConclusionBuddhist walking meditation exercise produced a multitude of favorable effects, often superior to traditional walking program, in patients with type 2 diabetes.

A clinical study of the anti-diabetic effect of a simple Chinese herbal formula, PSP-1

IntroductionA two armed clinical before and after study was conducted to investigate the efficacy of a proprietary Chinese herbal formula, PSP-1, to improve glycemic control in type 2 diabetic patients and pre-diabetic subjects over a 3 month period. MethodsSixty-two subjects were recruited and divided into a Diabetic Group (DG) and a Pre-diabetic Group (PG). All subjects were prescribed PSP-1 or placebo and followed-up for 3 months. Blood and spot urine samples were collected at baseline, 1st month and 3rd month for each subject for laboratory tests. ResultsFor the DG group, PSP-1 subjects showed significant decrease in blood HbA1c level between baseline and 3 months post PSP-1 (p<0.005), but there was no significant change in fasting plasma glucose concentration. PSP-1 subjects in the PG group showed a significant decrease in both fasting glucose (p<0.05) and HbA1c (p=0.001) after 3-months’ treatment. Combining PG and DG groups, a significant decrease in HbA1c was observed for PSP subjects between baseline and 3 months post PSP. Comparison with those on placebo demonstrated no significant changes in either HbA1c level or glucose concentrations. ConclusionsIt appeared that 3 months supplementation of PSP-1 formulation was able to reduce blood glucose concentrations in pre-diabetic subjects and lowered blood HbA1c levels for both pre-diabetic and diabetic subjects.

Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review.

BackgroundDiabetes and periodontal disease share common features in terms of inflammatory responses. Current scientific evidence suggests that treatment of periodontal disease might contribute to glycemic control. The objective of the study is a review of the last three years.Material and MethodsA literature search was performed in the MEDLINE (PubMed), Cochrane, and Scopus databases, for articles published between 01-01-2013 and 30-06-2015, applying the key terms “periodontal disease” AND “diabetes mellitus”. The review analyzed clinical trials of humans published in English and Spanish.ResultsThirteen clinical trials were reviewed, representing a total of 1,912 patients. Three of them had samples of <40 patients, making a total of 108 patients and the remaining ten samples had >40 patients, representing a total of 1,804. Only one article achieved a Jadad score of five. Seven articles (998 patients, 52.3% total), presented a statistically significant decrease in HbA1c (p< 0.05) as a result of periodontal treatment. In the six remaining articles (representing 914 patients, 47.8% of the total), the decrease in HbA1c was not significant. Patient follow-up varied between 3 to 12 months. In three articles, the follow-up was of 3, 4, and 9 months, in two 6 and 12 months.ConclusionsThe majority of clinical trials showed that radicular curettage and smoothing, whether associated with antibiotics or not, can improve periodontal conditions in patients with diabetes mellitus. However, few studies suggest that this periodontal treatment improves metabolic control. However, there is no clear evidence of a relation between periodontal treatment and improved glycemic control in patients with type 2 diabetes mellitus. Key words:Diabetes, periodontal disease, HbA1c, metabolic control.

The impact of medication-focused workshops in a diabetes educational program in jail: a pilot study.

Correctional institutions have unique circumstances offering care and the opportunity to adopt healthy behaviours for populations suffering from chronic diseases such as diabetes. In view of their expertise on medication, pharmacists can contribute to multidisciplinary educational health programmes in prisons. To assess the effectiveness of a pharmacist led diabetes medication-related workshops. Pharmacists led workshops about patients' empowerment in their treatment within the educational program. On a prospective observational study basis, the impact was assessed in terms of relevance, learning outcomes and achievement transfer using the Kirkpatrick training assessment method. Hb1Ac was measured as glycemic control outcome. Fifteen patients involved in the workshops showed a significant decrease in HbA1c compared to the control group (-1.18 ± 0.52 vs. +0.26 ± 0.28 %; p < 0.001). All participants were satisfied and ready to join other sessions. (LO) Postworkshop scores were significantly improved (LO1: 4.2 ± 0.9 vs. 2.2 ± 1.4; LO2: 4.5 ± 0.9 vs. 2.6 ± 1.3; p < 0.05). Decrease in HbA1c was correlated to increase in LO2's scores. (Y = 0.946 - 1.134X; R = -0.692; p < 0.05). ACHIEVEMENT TRANSFER: Key points from all LOs were reported. In case studies, 70 % of participants adopted healthy strategies (LO3). These results highlight the positive impact of the workshops and the additive value of pharmacists' involvement within the educational program in jail.

Use of V-Go® Insulin Delivery Device in Patients with Sub-optimally Controlled Diabetes Mellitus: A Retrospective Analysis from a Large Specialized Diabetes System.

IntroductionTight glycemic control and timely treatment can improve outcomes in patients with diabetes yet many remain sub-optimally controlled. The objective of the current study was to evaluate the effect of switching patients with sub-optimally controlled diabetes to the V-Go® (Valeritas Inc., Bridgewater, NJ, USA) Disposable Insulin Delivery device.MethodsA retrospective analysis of electronic medical records was conducted to assess patients with sub-optimal glycemic control defined as a glycated hemoglobin (HbA1c) >7%, switched to V-Go. Blood glucose control defined as change from baseline in HbA1c, prescribed insulin doses, body weight, concomitant anti-hyperglycemic agents, and reported hypoglycemia were collected prior to switching to V-Go and during V-Go use.ResultsTwo-hundred and four patients were evaluated during the study period. Overall, there was a significant decrease in HbA1c after switching to V-Go at the 14- and 27-week follow-up visits. The least-squares mean (LSM) change in HbA1c (95% confidence interval) from baseline to 14 weeks was −1.53% (−1.69% to −1.37%; P < 0.001), and from baseline to 27 weeks was −1.79% (−1.97% to −1.61%; P < 0.001). Significant reductions in mean HbA1c were achieved at both visits in all patient subsets: Patients with type 2 and type 1/latent autoimmune diabetes in adults (LADA); patients using insulin at baseline and patients naïve to insulin at baseline. Patients administering insulin at baseline required significantly less insulin on V-Go (86–99 LSM units/day at baseline to 58 LSM units/day at 27 weeks; P < 0.001). Across all patients, reported hypoglycemic events were no more frequent on V-Go than on previous therapy.ConclusionV-Go is safe and effective in patients with sub-optimally controlled diabetes requiring insulin therapy. Glycemic control improved significantly, less insulin was required, and hypoglycemic events were similar after patients switched to insulin delivery by V-Go.FundingValeritas, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-015-0138-7) contains supplementary material, which is available to authorized users.

Use of a basal-plus insulin regimen in persons with type 2 diabetes stratified by age and body mass index: A pooled analysis of four clinical trials

AimsTo evaluate the efficacy and safety of adding a single bolus dose of insulin glulisine to basal insulin (‘basal-plus’) in persons with type 2 diabetes. MethodsData from patients with poor glycemic control on oral antihyperglycemic drugs who were initiated on a ‘basal-plus’ regimen for up to 6 months were pooled from four randomized, multicenter studies. Glycated hemoglobin (HbA1c), fasting blood glucose, postprandial glucose (PPG), insulin dose and demographics were measured at baseline and end of study. Results711 patients with a mean age of 59.9 years and a mean duration of diabetes of 11.0 years were included in the analysis population. A ‘basal-plus’ regimen was associated with significant decreases in HbA1c and PPG at 6 months, an increase in glargine and glulisine doses and small, but statistically significant, changes in body weight and BMI in all patient subsets. The proportion of patients with HbA1c<7% also increased in all populations studied, while the prevalence of severe hypoglycemia was low and did not significantly differ across patient groups. ConclusionsThese results suggest that the use of ‘basal-plus’ can achieve a good therapeutic response with a low risk of hypoglycemia and weight gain, regardless of a patient's age or BMI.