Significant Reduction In HbA1c Research Articles

Glycemic Control and Body Weight Reduction with Once-Weekly Semaglutide in Colombian Adults with Type 2 Diabetes: Findings from the COLIBRI Study.

Type 2 diabetes is a prevalent condition. The change in glucose control and body weight with the use of once-weekly semaglutide was evaluated in individuals with Type 2 diabetes in Colombia. This was a real-world, multi-centre, single-arm study involving adults in Colombia with Type 2 diabetes treated with once-weekly subcutaneous semaglutide for approximately 26 weeks. The primary endpoint assessed the change in glycated hemoglobin (HbA1c) from baseline to end of study. Secondary endpoints included changes in body weight from baseline to end of study. The study also explored the proportion of participants achieving predefined HbA1c targets and weight-loss responses at the end of the study. Data from 225 patients across 11 centers were collected. Most patients were women (65%), and the mean age of the population was 57 years with a median HbA1c of 7.6% and a median body weight of 86 kg. After approximately 26 weeks, semaglutide was associated with a significant reduction in HbA1c of -0.88 and a body weight reduction of -4.04kg. The proportion of patients with HbA1c < 7% increased from 32 to 66% at end of study. Patients treated with once-weekly semaglutide experienced a clinically significant reduction in HbA1c and body weight. These results are in line with previous clinical trials.

Real-world Impact of 3 and 4.5 mg Doses of Dulaglutide on Weight and Hemoglobin A1c in Patients With Type 2 Diabetes Mellitus.

Limited real-world data on the benefits and risks associated with 3 and 4.5 mg doses of dulaglutide currently exists, making it difficult to determine the impact of dose titration for patients currently managed with dulaglutide 1.5 mg weekly. To determine the impact of dulaglutide 3 and 4.5 mg doses on weight and hemoglobin A1c (HbA1c) in patients with type 2 diabetes mellitus (T2DM), in clinical practice. Retrospective, observational study of adult T2DM patients receiving dulaglutide 3 or 4.5 mg weekly within a large, university-affiliated, primary care network. The primary outcome was change in weight and HbA1c from baseline to 24 weeks. Secondary outcomes included incremental changes in weight and HbA1c, and describing trends related to dose reductions. Ninety-five patients were included, 62 in the dulaglutide 3 mg group and 33 in the dulaglutide 4.5 mg group. After 24 weeks, the mean changes in weight and HbA1c from baseline were -1.8 kg (P < 0.01) and -0.4% (P < 0.01) in the 3 mg group, and -4.2 kg (P < 0.01) and -0.4% (P = 0.119) in the 4.5 mg group. Incremental change in weight and HbA1c among patients who were titrated from dulaglutide 3 to 4.5 mg weekly were -2.6 kg (P < 0.01) and -0.2% (P = 0.04), respectively. Titration from dulaglutide 1.5 to 3 mg resulted in significant reductions in weight and HbA1c after 24 weeks. Additional, statistically significant, reductions in weight and HbA1c were seen when patients were further titrated to dulaglutide 4.5 mg weekly.

#2926 The impact of GLP-1 receptor agonists on metabolic control and diabetic kidney disease progression

Abstract Background and Aims Diabetic kidney disease is the leading cause of end-stage kidney disease in developed world. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are a class of drugs that have shown benefits beyond glycemic control, with a reduction in cardiovascular risk and renoprotective effects. The aim of this study was to assess the effect of GLP-1 RA in metabolic control and progression of CKD. Our objective was to analyze the impact and efficacy of GLP-1 RA in patients with chronic kidney disease (CKD). Method This was a retrospective cohort study, that included type 2 diabetic patients with CKD, followed in Nephrology outpatient clinic, who started treatment with GLP-1 RA between January 2019 and February 2022. Clinical, demographic and laboratory data were collect at the initiation of the therapy, 6 months and 1 year during follow-up. Results A total of 66 patients were included, of whom 63.6% (n = 42) males with a mean age of 67.8 ± 10.9 years. 95.5% (n = 63) had history of hypertension, 59.1% (n = 39) heart failure and 16.7% (n = 11) peripheral arterial disease. The median estimated glomerular filtration rate (eGFR) at beginning of the treatment was 45 [31.8-65] mL/min/1.73 m2, mean HbA1c of 9.1 ± 1.7%, and mean weight 89.4 ± 15.4 kg. The most frequently prescribed GLP-1 RA were liraglutide (34.8%, n = 23) and dulaglutide (34.8%, n = 23), followed by semaglutide (21.2%, n = 14) and exenatide (1.5%, n = 1). Regarding concomitant therapy, all of the patients were on renin-angiotensin-aldosterone system antagonists, 90.9% (n = 60) were on SGLT2 inhibitors, and 68.2% (n = 45) were on insulin. At 6 months follow-up, there was a statistically significant reduction in HbA1c (9.2 ± 1.8 VS 7.8 ± 1.7, p &amp;lt; 0.001) and weight (89.4 ± 15.4 VS 86.8 ± 15.7, p = 0.002). There were no significant differences in eGFR, lipidic profile and albuminuria. At 1 year follow-up, there was significant reduction of HbA1c (Z = −4.6, p &amp;lt; 0.001), weight (Z = −3.1, p = 0.002), and a statistically significant increase of eGFR (49.5 ± 25.4 VS 56.9 ± 27.0, p = 0.007), with no significant differences in lipidic profile and albuminuria. During the follow-up period, 5 patients voluntarily discontinued the treatment, and 1 patient suspended it due to gastrointestinal adverse effects. Conclusion Our study findings reinforce the existing evidence supporting the renoprotective effects of GLP-1 RA. We observed a notable improvement in metabolic control, as evidenced by significant reduction of HbA1c and weight, particularly at the 6th month. There were no significant differences in albuminuria during the follow up time, but an unexpected increase in eGFR.

Efficacy and safety of advanced hybrid closed loop systems in children with type 1 diabetes younger than 6 years

BackgroundTight glycemic control is essential for the normal growth and development of preschool children. The aim of our study was to evaluate the impact of advanced hybrid closed loop (AHCL) systems in a real-life setting in children younger than 6 years.MethodsWe conducted a two-center prospective study. We enrolled 19 patients with a median age at disease onset of 2.6 years [interquartile range (IQR) 1.6; 4.4] and a median disease duration of 1.4 years (IQR 0.9; 2.8) who were switched to AHCL from multiple daily injections or open-loop insulin therapy and with a 6-month follow-up. Clinical data, sensor glycemic metrics, and pump settings were collected and analyzed.ResultsAfter 6 months of follow-up, there was a significant reduction in median HbA1c (p = 0.0007) and glucose management indicator (p = 0.03). A reduction in both mild (&amp;gt;180 mg/dL) (p = 0.04) and severe (&amp;gt;250 mg/dL) (p = 0.01) hyperglycemia was observed after 1 month of auto mode, and in mild hyperglycemia, it persisted up to 6 months (p = 0.02). A small increase in time below range (&amp;lt;70 mg/dL) was observed (p = 0.04) without a significant difference in time &amp;lt;54 mg/dL (p = 0.73). Time in range increased significantly, reaching a 10% increment (p = 0.03) compared with baseline. A significant reduction in the average sensor glucose was observed (p = 0.01) while coefficient of glucose variability (CV%) remained stable (p = 0.12). No episodes of ketoacidosis or severe hypoglycemia have been recorded.ConclusionAHCL systems are effective and safe for children younger than 6 years and should be considered as a valid therapeutic option from diabetes onset.

The effect of nutritional education on blood glycemic, lipidemic, and body mass index control among sample of type 2 diabetes.

Type 2 diabetes mellitus is a chronic metabolic disorder, characterized by poor glycemic control nutritional education enhances people's knowledge on healthy food choices that improve blood glycemic and lipidemic control leading to better overall health. This study is to examine the effect of nutritional education on the glycemic/lipidemic control and the body mass index in patient with type 2 diabetes mellitus. A quasi-experimental study was conducted on 40 patients with type 2 diabetes mellitus and recruited by non-probability convenience sampling method over 3months duration. BMI, HbA1c, total cholesterol, low density lipoprotein-C, high density lipoprotein-C, and triglyceride were measured at baseline and after 3months during which during which five nutritional educational lectures were done. After 3months of nutritional education, there were a significant reduction in HbA1c % from 9.53 to 8.09 (P < 0.001) and body mass index from 32.19 to 31.58 (P = 0.001) and also slight but non-significant changes in cholesterol, LDL, triglyceride, and HDL (7.05 ± 38.428, 5.00 ± 29.858, 9.10 ± 85.386, 0.24 ± 3.612 respectively) (P = 0.253, 0.296, 0.668, and 0.504 respectively). Nutritional education program is effective to decrease HbA1c % and body mass index.

Could Online Education Replace Face-to-Face Education in Diabetes? A Systematic Review.

Diabetes Self-Management Education and Support (DSMES) is a critical component of diabetes care. This study aims to examine the effect of online-based educational interventions on diabetes management compared to face-to-face interventions. A systematic review was conducted by searching three databases for studies in English or Spanish between December 2023 and March 2024. The inclusion criteria were studies that compared face-to-face DSMES with online interventions. The follow-up duration of the trials ranged from 1 to 12months. Multidisciplinary teams delivered online DSMES through various means, including Short Message Service (SMS), telephone calls, video calls, websites, and applications. Online DSMES was found to be comparable to face-to-face interventions in terms of glycated hemoglobin (HbA1c) levels in people with type 1 diabetes (T1D). In contrast, online interventions that focus on weight management in people with type 2 diabetes (T2D) have shown a significant reduction in HbA1c compared to face-to-face interventions. Online DSMES was found to be superior in terms of quality of life and cost-effectiveness in both T1D and T2D. None of the analyzed studies explored the differences between individual and group methodologies. The current evidence indicates that online DSMES services provide at least comparable biomedical benefits to face-to-face interventions, suggesting that online interventions could be incorporated into clinical practice as a complement or reinforcement. However, further research is needed to explore the potential benefits and effectiveness of online group sessions in DSMES.

Safety and efficacy of GLP-1 and glucagon receptor dual agonist for the treatment of type 2 diabetes and obesity: a systematic review and meta-analysis of randomized controlled trials.

This study aimed to investigate the effects of randomized, placebo-controlled trials involving the GLP-1 and glucagon receptor dual agonists, mazdutide, and cotadutide, on glycaemic control and body weight changes in individuals with type 2 diabetes mellitus (T2DM), obesity, or both. We conducted searches in Medline, PubMed, Scopus, the Cochrane database, and Web of Science up to March 5, 2024. The primary outcomes assessed were changes in HbA1c level and percentage changes in body weight from baseline (CFB). Eleven studies and four unpublished trials were included. The pooled meta-analysis revealed a significant reduction in HbA1c (MD = -0.63%; 95% CI = [-0.82, -0.44]; P < 0.00001), fasting plasma glucose (MD = -1.71 mmol/L; 95% CI = [-2.31, -1.10]; P < 0.00001), and percentage change in body weight (MD = -4.16%; 95% CI = [-5.41, -2.92]; P < 0.00001). Safety analysis revealed no significant change in serious adverse events (OR = 1.03; 95% CI = [0.61, 1.75]; P = 0.91), but there were significantly higher odds of treatment-emergent adverse events (OR = 2.52; 95% CI = [1.92, 3.30]; P < 0.00001) and vomiting (OR = 6.05; 95% CI = [3.52, 10.40]; P < 0.00001). These results suggest that mazdutide and cotadutide are effective for glycaemic control and weight reduction in individuals with T2DM, obesity, or both.

THE EFFECTS OF DOWNHILL WALKING ON INSULIN SENSITIVITY, ARTERIAL HEALTH, MUSCLE STRENGTH AND FUNCTIONAL PHYSICAL FITNESS IN PEOPLE WITH TYPE 2 DIABETES MELLITUS

INTRODUCTION &amp; AIMS Exercise is effective in preventing and managing Type 2 Diabetes Mellitus (T2DM). However, a significant number of people do not exercise as they perceive exercise to be physically challenging. Eccentric exercise, a novel aerobic exercise modality is less metabolically demanding and has been shown to have positive effects on blood glucose levels, cardiovascular fitness, and muscle strength in healthy populations. This research was conducted to explore the impact of eccentric exercise, specifically downhill walking, on insulin sensitivity, arterial health, muscle strength, and physical functional fitness in individuals with T2DM. METHODS A 12-week randomised controlled trial was conducted to investigate the effects of downhill, level, and uphill walking on people with T2DM. Sedentary adult participants with T2DM were randomised to perform downhill walking (DW), level walking (LW), or uphill walking (UW) for 30 minutes twice a week for twelve weeks at a standard speed of 2.5km/hr. The primary outcome measure was glycosylated haemoglobin (HbA1c), while secondary measures included arterial stiffness, strength, and physical fitness. RESULTS A significant reduction in HbA1c between baseline and 12 weeks was observed in the UW group However, per-protocol analysis showed a significant decrease in HbA1c in the DW group post-intervention as well. Central Systolic blood pressure significantly decreased between baseline and post-intervention in the DW group. Participants in DW group and UW group showed significant improvements in distance walked in 6MWT post-intervention. A significant increase in knee extensors isometric strength between baseline and 12 weeks was observed for the DW group only. CONCLUSION DW was as effective as UW for improving insulin sensitivity and more effective than LW and UW for improving central systolic blood pressure, muscle strength and functional physical fitness. DW is a viable option for those seeking a less demanding form of exercise.

Prevention of diabetes from prediabetes in real world setting in South India

AimThe aim was to explore the effect of lifestyle modification in a real world situation to prevent the progression to diabetes in India. MethodsParticipants who underwent OGTT from August 2017–2022 and were diagnosed as having Prediabetes (n = 200) were assigned into control (group1, n = 100) received standard care and intervention (group2, n = 100) received intensive counseling on physical activity (PA) and diet. PA included walking for 150 min/week and personalized advice based on the profession. OGTTs were repeated once every 6 months for 5 years and primary outcome was development of DM. ResultsThe conversion rate was significantly higher in the control group than the intervention group (44.6 vs.7.9 %, p < 0.0001). Individuals who reverted back to normal was significantly higher in Group2 compared to Group1 (34.9 vs.6.2 %; p < 0.001). A significant increase in weight, BMI and waist circumference in group1 and significant reduction in glucose and HbA1c was noted in group2. Mean (95%CI) survival time for Group1 was 25.4 (20.8–29.9) and Group2 was 36.4months (32.6–40.1; p < 0.001). The factors which influenced the conversion of prediabetes to DM were averaged BMI, fasting and 2hr glucose levels of all follow up visit measurements. ConclusionWe can prevent diabetes in individuals with prediabetes using real world strategies in India.

Continuous glucose monitoring for glycaemic control and cardiovascular risk reduction in patients with type 2 diabetes not on insulin therapy: A clinical trial.

To evaluate the impact of the Dexcom G6 continuous glucose monitoring (CGM) device on glycaemic control and cardiometabolic risk in patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk who are not on insulin therapy. Adults with T2DM with glycated haemoglobin (HbA1c) >7% and body mass index (BMI) ≥30 kg/m2 not using insulin were enrolled in a two-phase cross-over study. In phase 1, CGM data were blinded, and participants performed standard glucose self-monitoring. In phase 2, the CGM data were unblinded, and CGM, demographic and cardiovascular risk factor data were collected through 90 days of follow-up and compared using paired tests. Forty-seven participants were included (44% women; 34% Black; mean age 63 years; BMI 37 kg/m2; HbA1c 8.4%; 10-year predicted atherosclerotic cardiovascular disease risk 24.0%). CGM use was associated with a reduction in average glucose (184.0 to 147.2 mg/dl, p < .001), an increase in time in range (57.8 to 82.8%, p < .001) and a trend towards lower glucose variability (26.2 to 23.8%). There were significant reductions in HbA1c, BMI, triglycerides, blood pressure, total cholesterol, diabetes distress and 10-year predicted risk for atherosclerotic cardiovascular disease (p < .05 for all) and an increase in prescriptions for sodium-glucose cotransporter 2 inhibitors (36.2 to 83.0%) and glucagon-like peptide-1 receptor agonists (42.5 to 87.2%, p < .001 for both). Dexcom G6 CGM was associated with improved glycaemic control and cardiometabolic risk in patients with T2DM who were not on insulin. CGM can be a safe and effective tool to improve diabetes management in patients at high risk for adverse cardiovascular outcomes.

The Effect of Telemedicine on Self-Care Activities of Patients with Type 2 Diabetes Mellitus and Patient Satisfaction During the Coronavirus-19 (COVID-19) Pandemic: A Repeated Cross-Sectional Study

Introduction: Patients with diabetes require regular follow-ups to achieve optimal glycemic targets. The coronavirus- 19 (COVID-19) pandemic resulted in interruptions in healthcare delivery placing greater importance on patient’s self-management of their condition. Telemedicine bridged the gap between the physician and patient that was created by community quarantines. Objective: To determine if there is a difference in patient’s self-care activities before and after using telemedicine using the Diabetes Self-Management Questionnaire (DSMQ). Methodology: A descriptive repeated cross-sectional study of patients with type 2 diabetes mellitus at the University of Santo Tomas Hospital who consulted via telemedicine using different available platforms were included. Self-care was measured using the DSMQ. Patient satisfaction with telemedicine was also assessed using a patient satisfaction survey. Results: An improvement in self-care practices was seen as significantly higher mean DSMQ scores after telemedicine consultations (6.79 ± 1.33 to 7.32 ± 1.21, p = 0.0015), with the highest scores on dietary control and physical activity. There was a statistically significant reduction in HbA1c on follow up (8.37 ± 2.31 to 7.31 ± 1.36; p&lt;0.00001). Those with well-controlled diabetes (n = 14) at baseline remained to have good control while the proportion of those with poorly controlled diabetes (n = 34) showed improved glycemic control on follow up (p = 0.0045). Most patients were highly satisfied with telemedicine. Conclusion: The use of telemedicine by patients with diabetes showed numerical improvement in both self-care practices and glycemic control. These findings imply that telemedicine may be mainstreamed as part of diabetes care among Filipinos. Keywords: COVID-19, telemedicine, diabetes, self-care activities

Comparative Effectiveness of Hybrid Closed-Loop Automated Insulin Delivery Systems Among Patients with Type 1 Diabetes.

Clinical trials have demonstrated the efficacy and safety of hybrid closed-loop (HCL) systems, yet few studies have compared outcomes in the real-world setting. This retrospective study analyzed patients from an academic endocrinology practice between January 1, 2018, and November 18, 2022. The inclusion criteria were diagnosis code for type I diabetes (T1D), >18 years of age, new to any HCL system [Medtronic 670G/770G (MT), Tandem Control IQ (CIQ), or Omnipod 5 (OP5)], and availability of a pump download within three months. The outcomes included %time in range (TIR) of 70 to 180 mg/dL, %time below range (TBR) <70 mg/dL at 90 days, and HbA1c for 91 to 180 days. Of the 176 participants, 47 were MT, 74 CIQ, and 55 OP5. Median (25%, 75%) change in HbA1c was -0.1 (-0.8, 0.3), -0.6 (-1.1, -0.15), and -0.55 (-0.98, 0)% for MT, CIQ, and OP5, respectively, (P = .04). TIR was 70 (57, 76), 67 (59, 75), and 68 (60, 76)% (P = .95) at 90 days while TBR was 2 (1, 3), 1 (0, 2), and 1 (0, 1)%, respectively, (P = .002). The %time in automated delivery was associated with TIR and change in HbA1c. After controlling other factors including %time in automated delivery, HCL type was not an independent predictor of change in HbA1c nor TIR but remained a significant predictor of TBR. There were significant reductions in HbA1c in CIQ and OP5. TIR was similar across pumps, but TBR was highest with MT. The %time in automated delivery likely explains differences in change in HbA1c but not TBR between HCL systems.

Evaluating the Efficacy and Safety of Tirzepatide on Glycaemic and Non-glycaemic Outcomes in Diabetes: A Systematic Review of Meta-Analyses.

Tirzepatide is a novel once-a-week dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, recently approved for type 2 diabetes mellitus (T2DM) and obesity. A systematic review of the literature published in multiple meta-analyses on Tirzepatide with emphasis on its effect on glycaemic and non-glycaemic parameters was conducted. We systematically searched the electronic databases PubMed and Google Scholar up to August 2023 for meta-analyses that compared Tirzepatide with placebo or active antihyperglycaemic drugs in subjects with T2DM. Various parameters for efficacy and safety, with their point estimates and confidence intervals, such as glycated haemoglobin (HbA1c), fasting serum glucose (FSG), body weight, lipid, and cardiovascular outcomes were assessed. Six meta-analyses fulfilled the pre-specified criteria and were included in the study. In all the studies, Tirzepatide treatment at different doses resulted in a significant reduction in HbA1c and FSG levels along with a significant reduction in weight compared with active control and placebo groups. Tirzepatide significantly reduced levels of triglycerides and increased high-density lipoprotein (HDL) cholesterol, whether used as monotherapy or add-on therapy. The studies suggested the cardiovascular safety ofTirzepatide as there was no increase in major adverse cardiovascular events(MACE). The drug shows lesser hypoglycemia but predominant gastrointestinal adverse effects such as nausea, vomiting, and diarrhoea. In conclusion, Tirzepatide shows superior glycaemic control and weight loss in patients with T2DM with beneficial effects on lipids, without an increased risk of hypoglycemia and cardiovascular events.

Abstract P146: Strength Training Effectiveness in Normal-Weight Type 2 Diabetes Amongst Asian Americans

Introduction: Normal weight type-2 diabetes (NWD), characterized by body mass index (BMI) below 25 kg/m 2 , is more prevalent amongst Asian Americans (AA). While recent studies have shown strength training (ST) was superior to aerobic (AER) or combination training (COMB) in lowering HbA1c levels in individuals with NWD, it is unclear if these exercises have the same effects across AA subgroups, which differentiate due to cultural norms. Methods: We used data from a 9-month randomized control trial for NWD (conducted in San Francisco Bay Area in 2019-2020) to evaluate the effectiveness of weekly planned ST, AER, and COMB training sessions for Chinese and Asian Indian populations. Our primary outcome was change in diabetic control (HbA1c). Secondary outcomes included changes in body composition (e.g. fat and lean mass) and muscle strength (e.g. leg extension).We performed intention-to-treat (ITT) and per-protocol analysis (PP, restricted to those with 50% minimum adherence) to evaluate changes to HbA1c and body composition using repeated measures ANOVA and paired t-tests. Results: Of 129 participants, 59 were Chinese (19 ST, 20 AER, 20 COMB), and 70 were Asian Indian (26 ST, 20 AER, 24 COMB). Average baseline HbA1c was 7.5% for both groups (p=0.96). Chinese participants (77.3%) showed higher adherence than Asian Indian (56.6%) participants. Chinese participants showed reduced HbA1c for each intervention group (ITT: ST -0.42% [-0.742, -0.11], AER -0.6% [-0.92 -0.28], and COMB -0.13% [-0.43, 0.17], all p &lt; 0.05), with AER intervention yielding the largest decrease (p&lt;0.01). Results from PP provided a similar conclusion. Asian Indians had no meaningful reductions in HbA1c levels ( ITT: ST -0.36% [-0.83, -0.11], AER 0.26% [-0.27, 0.78], and COMB -0.42% [-0.97, 0.13]. For body composition, Chinese participants showed significantly reduced FMI-Z (ST: -1.03 [-1.94, -0.12], AER: -0.17 [-0.31, -0.04], COMB: -0.17 [-0.23, -0.10]) in all intervention groups. Asian Indian participants only showed significant reduction in FMI-Z (fat mass adjusted for height, age, sex) in the ST group -0.22 [-0.40, -0.03]. Body composition changes were associated with improvement in HbA1c. Conclusion: Overall, AA persons in over 50% of prescribed exercise improved their diabetic control. In Chinese participants, all interventions lowered HbA1c with higher reductions observed in ST and AER interventions. They also experienced significant reductions in fat mass in all exercise interventions. Asian Indian participants showed no significant reductions in HbA1c in any exercise intervention, but showed significant reductions in fat mass in ST. By recognizing unique cultural and social factors that influence AA behaviors and choices, healthcare professionals can develop tailored interventions that foster cultural understanding, thus empowering individuals to take control of their health and reduce the burden of diabetes.

The benefits of hypoglycemic therapy for patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is often associated with glycemic abnormalities. This study is conducted to investigate the effects of hypoglycemic therapy on OSA-related indicators. We systematically searched Web of Science, PubMed, Embase, and the Cochrane Library for articles on OSA patients receiving any hypoglycemic drugs, published until December 25, 2022. Seven original studies were finally included. The proposal was registered with PROSPERO (CRD42022351206). In summary, in addition to reduced glycosylated hemoglobin A1c (HbA1c), we found that hypoglycemic treatment can lower the apnea-hypopnea index (AHI) by 7.07/h (p = 0.0001). Although long-term treatment (> 12 weeks) achieved a more significant reduction in HbA1c (- 1.57% vs. - 0.30%) compared to short-term treatment (≤ 12 weeks), there was no significant difference between the two in terms of AHI (intergroup p-value = 0.27). We also found that patients using sodium glucose cotransporter 2 inhibitors (SGLT2i) experienced a greater reduction in AHI (- 11.00/h, p < 0.00001). Additionally, hypoglycemic treatment also showed certain improvements in related indicators like Epworth Sleepiness Scale, body mass index, and blood pressure. Our results affirm the benefits of hypoglycemic treatment for OSA patients and highlight the notable effect of SGLT2i. Further researches are needed to help doctors gain a comprehensive understanding of the interaction between OSA and glycemic abnormalities.

Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus: A real-world experience.

Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are a class of drugs with modest antidiabetic efficacy, weight loss effect, and cardiovascular benefits as proven by multiple randomised controlled trials (RCTs). However, real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse. To study the comparative efficacy and safety of SGLT-2i using real-world clinical data. We evaluated the comparative efficacy data of 3 SGLT-2i drugs (dapagliflozin, canagliflozin, and empagliflozin) used for treating patients with type 2 diabetes mellitus. Data on the reduction of glycated hemoglobin (HbA1c), body weight, blood pressure (BP), urine albumin creatinine ratio (ACR), and adverse effects were recorded retrospectively. Data from 467 patients with a median age of 64 (14.8) years, 294 (62.96%) males and 375 (80.5%) Caucasians were analysed. Median diabetes duration was 16.0 (9.0) years, and the duration of SGLT-2i use was 3.6 (2.1) years. SGLT-2i molecules used were dapagliflozin 10 mg (n = 227; 48.6%), canagliflozin 300 mg (n = 160; 34.3%), and empagliflozin 25 mg (n = 80; 17.1). Baseline median (interquartile range) HbA1c in mmol/mol were: dapagliflozin - 78.0 (25.3), canagliflozin - 80.0 (25.5), and empagliflozin - 75.0 (23.5) respectively. The respective median HbA1c reduction at 12 months and the latest review (just prior to the study) were: 66.5 (22.8) & 69.0 (24.0), 67.0 (16.3) & 66.0 (28.0), and 67.0 (22.5) & 66.5 (25.8) respectively (P < 0.001 for all comparisons from baseline). Significant improvements in body weight (in kilograms) from baseline to study end were noticed with dapagliflozin - 101 (29.5) to 92.2 (25.6), and canagliflozin 100 (28.3) to 95.3 (27.5) only. Significant reductions in median systolic and diastolic BP, from 144 (21) mmHg to 139 (23) mmHg; (P = 0.015), and from 82 (16) mmHg to 78 (19) mmHg; (P < 0.001) respectively were also observed. A significant reduction of microalbuminuria was observed with canagliflozin only [ACR 14.6 (42.6) at baseline to 8.9 (23.7) at the study end; P = 0.043]. Adverse effects of SGLT-2i were as follows: genital thrush and urinary infection - 20 (8.8%) & 17 (7.5%) with dapagliflozin; 9 (5.6%) & 5 (3.13%) with canagliflozin; and 4 (5%) & 4 (5%) with empagliflozin. Diabetic ketoacidosis was observed in 4 (1.8%) with dapagliflozin and 1 (0.63%) with canagliflozin. Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c, body weight, and better than those reported in RCTs, with low side effect profiles. A review of large-scale real-world data is needed to inform better clinical practice decision making.

Single Center Evaluation of Long-Term Results of Glargin U-300 in Insulin Naive Patients In a Real-World Setting

Objective: Insulin therapy stands as one of the most effective and well-established therapeutic options for managing glycemic control in Diabetes Mellitus (DM). Glargine 300 U/mL (Gla-300) represents a new long-acting insulin analog, which has demonstrated a decrease in the risk of hypoglycemia and a reduction in the total number of injections due to prolonged insulin absorption. In this study, we investigated the long-term effects of Gla-300 on Fasting Plasma Glucose (FPG) and HbA1c levels, as well as the incidence of hypoglycemia in insulin-naive patients admitted to the Internal Medicine outpatient clinic, over a period of 0, 3, 6, 12, and 24 months.. Material and Methods: Between January 2018 and June 2022, insulin-naive patients diagnosed with Type 2 Diabetes Mellitus (T2DM) who initiated treatment with Gla-300 and sought care at the Internal Medicine outpatient clinic were subjected to retrospective analysis. Results: The study included 49 insulin-naive patients. A statistically significant decrease was observed in Fasting Plasma Glucose (FPG) (p = 0.03) and HbA1c (p = 0.02) levels during the 24-month follow-up period of Glargine U-300. Additionally, a significant reduction in both FPG (p &lt; 0.01) and HbA1c (p &lt; 0.01) values was achieved at the time of diagnosis and at 3 months. Hypoglycemia was reported in only 1 patient (2%) during our study, indicating a very low hypoglycemia rate. Conclusion: Diabetes mellitus (DM) poses a significant public health challenge, resulting in economic burden and diminished quality of life. Developed to address these challenges, Gla-300 serves as a long-acting basal insulin that effectively reduces the risk of hypoglycemia while offering targeted glycemic control, as evidenced by our study findings. In Turkey, there is a pressing need for multicenter, prospective real-world studies that incorporate parameters such as insulin dosage and weight monitoring.

Assessment of the impact of a personalised nutrition intervention in impaired glucose regulation over 26 weeks: a randomised controlled trial

Dietary interventions can reduce progression to type 2 diabetes mellitus (T2DM) in people with non-diabetic hyperglycaemia. In this study we aimed to determine the impact of a DNA-personalised nutrition intervention in people with non-diabetic hyperglycaemia over 26 weeks. ASPIRE-DNA was a pilot study. Participants were randomised into three arms to receive either (i) Control arm: standard care (NICE guidelines) (n = 51), (ii) Intervention arm: DNA-personalised dietary advice (n = 50), or (iii) Exploratory arm: DNA-personalised dietary advice via a self-guided app and wearable device (n = 46). The primary outcome was the difference in fasting plasma glucose (FPG) between the Control and Intervention arms after 6 weeks. 180 people were recruited, of whom 148 people were randomised, mean age of 59 years (SD = 11), 69% of whom were female. There was no significant difference in the FPG change between the Control and Intervention arms at 6 weeks (− 0.13 mmol/L (95% CI [− 0.37, 0.11]), p = 0.29), however, we found that a DNA-personalised dietary intervention led to a significant reduction of FPG at 26 weeks in the Intervention arm when compared to standard care (− 0.019 (SD = 0.008), p = 0.01), as did the Exploratory arm (− 0.021 (SD = 0.008), p = 0.006). HbA1c at 26 weeks was significantly reduced in the Intervention arm when compared to standard care (− 0.038 (SD = 0.018), p = 0.04). There was some evidence suggesting prevention of progression to T2DM across the groups that received a DNA-based intervention (p = 0.06). Personalisation of dietary advice based on DNA did not result in glucose changes within the first 6 weeks but was associated with significant reduction of FPG and HbA1c at 26 weeks when compared to standard care. The DNA-based diet was effective regardless of intervention type, though results should be interpreted with caution due to the low sample size. These findings suggest that DNA-based dietary guidance is an effective intervention compared to standard care, but there is still a minimum timeframe of adherence to the intervention before changes in clinical outcomes become apparent.Trial Registration:www.clinicaltrials.gov.uk Ref: NCT03702465.

Real-World Use of Oral and Subcutaneous Semaglutide in Routine Clinical Practice in the UK: A Single-Centre, Retrospective Observational Study.

Semaglutide, the only glucagon-like peptide-1 receptor agonist (GLP-1 RA) available in subcutaneous and oral formulation for treatment of type 2 diabetes (T2D), has demonstrated clinically significant improvements in glycaemic control and weight in clinical trials. This study aimed to gain insights into the use of both formulations and evaluate their clinical effectiveness in a secondary care clinic in Wales. This was a retrospective observational analysis of adults with T2D initiated on oral or subcutaneous semaglutide. Changes from baseline in glycated haemoglobin (HbA1c), weight and other metabolic parameters were evaluated. At baseline, participants (n = 103) had a mean age of 57.3years, mean HbA1c of 79.1mmol/mol (9.38%), mean weight of 111.8kg and body mass index (BMI) of 39.6kg/m2 (no statistically significant differences between oral and subcutaneous groups). At 6-month follow-up, statistically significant improvements in HbA1c (- 19.3mmol/mol [- 1.77%] and - 20.8mmol/mol [- 1.90%]), body weight (- 9.0kg and - 7.2kg), and BMI (- 3.3kg/m2 and - 2.5kg/m2) were observed for oral and subcutaneous semaglutide, respectively. No statistically significant differences between the formulations were observed, and safety profiles were comparable. Both formulations of semaglutide provided clinically and statistically significant reductions in HbA1c and weight in real-world practice. Oral GLP-1 RA may offer a practical and effective option for the management of T2D.

Antihypertensive effect of Dapagliflozin in Type II diabetic patients with Hypertension

Hypertension (HTN) and type II diabetes mellitus (T2DM) are two main cardiovascular risk factors that coexist frequently. The aim of this study is evaluation the antihypertensive effect of dapagliflozin in hypertensive type 2 diabetic patients (controlled/inadequately uncontrolled), and study its effect on contributing factors in that effectiveness (ex. weight loss and SNS damping). Primary endpoints included the effect of dapagliflozin on hemoglobin A1C (HbA1c) and blood pressure. Secondary endpoints included the effect of drug on weight body, pulse rate and pulse pressure. Patients were randomly selected from the outpatient of the Endocrinology Department at Tishreen University Hospital in Syria, and divided into two groups: dapagliflozin group (n=45) received 5 or 10mg dapagliflozin once daily as an add-on therapy to oral anti-diabetic drugs (OAD)and antihypertensive drugs, and control group (n=38) received OAD and antihypertensive drugs. After 12 weeks follow-up, dapagliflozin-treated versus control-treated showed significant reduction in HbA1C (-0.7% vs -0.3%, p&lt;0.05, mean seated SBP (-9.4 vs -1.2mmHg, p=0.0001) and mean seated DBP(-6 vs-0.3mmHg, p=0.0001). Dapagliflozin also reduced body weight compared with control (-2.6 vs -0.6kg, p=0.0001) andthere was a significant positive correlation between weight loss and BP reduction. The effect on pulse rate was modest and similar between two groups but dapagliflozin have lowered pulse pressure values. There was no significant dose-response with any studied parameter, too. 5mg dapagliflozin once daily improved glycemic control, reduced body weight, SBP more than DBP and thus improved pulse pressure. All that without any significant effect on pulse rate.