Significant Reduction In HbA1c Research Articles

A randomized, double-blind, placebo-controlled trial to evaluate the hypoglycemic efficacy of the mcIRBP-19-containing Momordica charantia L. fruit extracts in the type 2 diabetic subjects.

BackgroundThe fruits of Momordica charantia L., also named as bitter gourd or bitter melon in popular, is a common tropical vegetable that is traditionally used to reduce blood glucose. A peptide derived from bitter gourd, Momordica charantia insulin receptor binding peptid-19 (mcIRBP-19), had been demonstrated to possess an insulin-like effect in vitro and in the animal studies. However, the benefit of the mcIRBP-19-containing bitter gourd extracts (mcIRBP-19-BGE) for lowering blood glucose levels in humans is unknown.ObjectiveThis aim of this study was to evaluate the hypoglycemic efficacy of mcIRBP-19-BGE in subjects with type 2 diabetes who had taken antidiabetic medications but failed to achieve the treatment goal. Whether glucose lowering efficacy of mcIRBP-19-BGE could be demonstrated when the antidiabetic medications were ineffective was also studied.DesignSubjects were randomly assigned to two groups: mcIRBP-19-BGE treatment group (N = 20) and placebo group (N = 20), and were orally administered 600 mg/day investigational product or placebo for 3 months. Subjects whose hemoglobin A1c (HbA1c) continued declining before the trial initiation with the antidiabetic drugs were excluded from the subset analysis to further investigate the efficacy for those who failed to respond to the antidiabetic medications.ResultsThe oral administration of mcIRBP-19-BGE decreased with a borderline significance at fasting blood glucose (FBG; P = 0.057) and HbA1c (P = 0.060). The subgroup analysis (N = 29) showed that mcIRBP-19-BGE had a significant effect on reducing FBG (from 172.5 ± 32.6 mg/dL to 159.4 ± 18.3 mg/dL, P = 0.041) and HbA1c (from 8.0 ± 0.7% to 7.5 ± 0.8%, P = 0.010).ConclusionAll of these results demonstrate that mcIRBP-19-BGE possesses a hypoglycemic effect, and can have a significant reduction in FBG and HbA1c when the antidiabetic drugs are ineffective.

Clinical and biochemical outcomes of Sodium-Glucose CoTransporter-2 (SGLT2) Inhibitors in Type-2 Diabetes Mellitus Patients as a fourth oral anti diabetic medicine.

Objectives:To evaluate the clinical and biochemical effects of (SGLT2) inhibitors as a fourth oral anti-diabetic drug in patients with Type-2 diabetes mellitus (T2DM).Methods:In a tertiary hospital in Karachi, Pakistan, a retrospective assessment of patient medical records was conducted from January 1, 2017 to December 31, 2020.A total of one hundred patients (mean age [Standard Deviation]: 53.8 [9.63] years) with poorly controlled T2DM were included. Data was collected before the SGLT-2 inhibitor was added, as well as three and six months after the medicine was started. Weight, BMI, blood pressure (BP), HbA1c, SGPT, and Creatinine were measured at the start and during the studyResults:There was a significant reduction in HbA1c (p-value < 0.001) with a mean reduction (MR) of 0.81+1.02% at three months and 1.07+1.11% at six months. A mean weight reduction (p-value < 0.001) of 1.83+2.32 kg at three months and 4.02+6.04 kg at 6 months, respectively, was recorded. A mean BMI reduction of 0.69+0.95 kgm-2 at three months and 2.13+3.41 kgm-2 at six months of follow up, respectively were recorded. A systolic blood pressure (SBP) also showed a significant reduction (p-value < 0.05) with a MR of 5.9+15.76 mmHg at three months and 6.37+18.33 mmHg at 6 months, respectively. Non-significant variation in creatinine and SGPT was also noted.Conclusions:SGLT-2 is an effective oral anti-diabetic medicine that can help individuals with diabetes who are currently using glucose-lowering oral anti-diabetic medications. These medications can help diabetic patients stick to their regimen.

Antidiabetic Effect and Preference of Fenugreek with Dietary Modifications in Patients with Prediabetes

Objective: The prevalence of diabetes mellitus in India is increasing day by day. This study was conducted to assess the impact of fenugreek with controlled diet in prediabetic patients of with fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c). Study Design: Interventional parallel randomized control trial. Materials and Methods: A total of 280 prediabetics were included in the study. Patients were randomized and one group of patients received 10 g of fenugreek powder in hot water every day, whereas the second group did not receive it. Strict dietary controls were followed as per the guidelines of American Diabetic Association (ADA) protocols. The parameters were assessed on the first visit and every 3 months for 24 months. Results: Dietary addition of fenugreek leads to a reduction in blood glucose levels. Statistical analysis shows that there was a significant reduction in FBGlevels in the 24 months in the study group (P &lt; 0.001), whereas a significant reduction in HbA1c in the 24th month (P = 0.001). Half of the study participants (52.9%, 59.2%, and 57.1% at 6, 12, and 24 months, respectively) reported acceptable compliance about fenugreek treatment. Conclusion: Dietary addition of fenugreek can have a synergistic effect along with diet control on FBG and HbA1c.

Type 2 Diabetes Mellitus with Diabetic Gastroparesis and Occasional Liver Dysfunction Treated by Low Carbohydrate Diet

Diabetes mellitus (DM) has wider neurological complications. They include upper gastrointestinal (GI) symptoms, impaired motility, impaired gastric emptying (GE) and diabetic gastroparesis (DG), which are usually found. The patient was a 64-year-old man with type 2 diabetes (T2D) for 22-years. The patient weighed 74 kg with body mass index (BMI) 23.6 kg/m2, hemoglobin A1C (HbA1c) 9.2%, ankle brachial index (ABI) 1.19/1.23, AST 25 U/L(7-38), ALT 23 U/L(4-44), GGT 48 U/L(&lt;86), Chest X-P normal, and electrocardiogram (ECG) negative. When the patient was treated with low carbohydrate diet (LCD), a significant reduction in body weight and HbA1c was observed. Abdominal computerized tomography (CT) revealed multiple gall stone, dilated common bile duct and impaired GE, indicating DG. For endoscopic examination, much food residue was found in the stomach due to DG after 13 hours fasting. Treatment for DG was initiated by mosapride citrate hydrate. During clinical progress, occasional liver dysfunction was observed twice associated with elevation of AST 196 U/L, GGT 373 U/L and without symptoms, indicating cholestasis-type dysfunction. Some possible triggers may be involved in these episodes, such as gall stone, enlarged volume of stomach due to DG, overeating, overdrinking, and other factors. This impressive report will hopefully become a reference for developing diabetic practice and research.

Effect of Metformin on Anthropometric Measurements and Hormonal and Biochemical Profile in Patients with Prediabetes.

Objectives Metformin is the most widely preferred first-line oral antidiabetic agent that results in clear benefits in blood sugar regulation and diabetes-related complications. This study is aimed at assessing the effect of metformin on anthropometric, hormonal, and biochemical parameters in patients with prediabetes or insulin resistance. Methods A prepoststudy was conducted among 52 patients with prediabetes or insulin resistance who met the inclusion criteria. Weight, body mass index (BMI), and waist circumference were measured before and 12 months after metformin treatment. Serum concentrations of sex steroids, gonadotropins, and lipids were also assessed. Homeostasis model assessment (HOMA) index and quantitative sensitivity check (QUICKI) index scores were calculated before metformin treatment and after 12 months of use. Results After 12 months of metformin treatment, female patients had significant reduction in weight, BMI, and waist circumference after adjusting for age. Metformin use for 12 months resulted in significant reduction in mean fasting blood glucose and HbA1c in females only. Total cholesterol decreased significantly among men only and serum HDL-C showed a significant rise among females only. Serum LDL-C and triglycerides did not change significantly in females and males. Our study did now significant changes in ACTH and cortisol levels in both females and males after metformin treatment. Metformin use resulted in significant increase in luteinizing hormone (LH) and progesterone levels in males, while it was associated with significant increase in prolactin, follicular stimulating hormone (FSH), and dehydroepiandrostenedione-sulphate (DHEA-S) levels and significant decrease in total testosterone level in females. Conclusion Metformin treatment in females with prediabetes reduces BMI, waist circumference, fasting blood glucose, and HbA1c. The changes in the studied parameters differed significantly according to sex.

Effects of Probiotic Supplementation on Inflammatory Markers and Glucose Homeostasis in Adults With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Background: Several studies have revealed the effect of probiotic supplementation in patients with type 2 diabetes (T2DM) on the amelioration of low-grade inflammation, which plays an important role in the pathogenesis of T2DM. However, the effects of the clinical application of probiotics on inflammation in individuals with T2DM remain inconsistent. This study aims to investigate the comprehensive effects of probiotics on inflammatory markers in adults with T2DM. Methods: PubMed, Embase, Cochrane Library, and the Web of Science were searched to identify randomized controlled trials (RCTs) exploring the effect of probiotic supplementation on inflammatory markers in individuals with T2DM through March 11, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. We used a random-effects model to calculate the standardized mean difference (SMD) between the probiotic supplementation and control groups. Results: Seventeen eligible studies were selected with a total of 836 participants, including 423 participants in probiotic supplementation groups and 413 participants in control groups. Our study demonstrated that compared with the control condition, probiotic intake produced a beneficial effect in reducing the levels of plasma inflammation markers, including tumour necrosis factor-α (TNF-α) (SMD [95% CI]; −0.37 [−0.56, −0.19], p < 0.0001) and C-reactive protein (CRP) (SMD [95% CI]; −0.21 [−0.42, −0.01], p = 0.040), while it had no effect on the plasma interleukin-6 (IL-6) level (SMD [95% CI]; −0.07 [−0.27, 0.13], p = 0.520). In addition, our results support the notion that probiotic supplementation improves glycaemic control, as evidenced by a significant reduction in fasting blood glucose (FPG), HbA1c and HOMA-IR (SMD [95% CI]: −0.24 [−0.42, −0.05], p = 0.010; −0.19 [−0.37, −0.00], p = 0.040; −0.36 [−0.62, −0.10], p = 0.006, respectively). Conclusion: Our study revealed some beneficial effects of probiotic supplementation on improving inflammatory markers and glucose homeostasis in individuals with T2DM. Probiotics might be a potential adjuvant therapeutic approach for T2DM.

Very low-calorie diet in patients with longstanding type 2 diabetes mellitus: a study of real-world outcomes

Introduction: There is a paucity of evidence regarding the efficacy of a very low-calorie diet (VLCD) in the real-world setting. We evaluated outcomes in patients with type 2 diabetes mellitus (T2DM) who underwent VLCD. Methods: This retrospective observational study included all patients who had undergone VLCD from 2014 to 2017 (n=61). The VLCD consisted of an eight-week 800 kcal/day dietary restriction. Metabolic parameters and medications were recorded at baseline, immediately post-VLCD and at 6 and 12 months. Results: There was a significant reduction in weight of 9.96 kg (p&lt;0.001) immediately post-VLCD, with net weight loss sustained to 12 months (p&lt;0.05). There was a significant reduction in body mass index (BMI) sustained to 12 months (p&lt;0.05). Paired HbA1c data were available for 38 patients. There was a significant reduction in HbA1c of 13.29 mmol/mol immediately post-VLCD (p&lt;0.001), however no significant reduction was observed at 12 months (p&gt;0.05). 78.7% patients had a reduction in T2DM medication burden post-VLCD, sustained in 44.3% of patients at 12 months. Analysis of patients with T2DM diagnosis duration &gt;6 years demonstrated statistically significant weight loss sustained to 12 months (p&lt;0.001). Conclusion: Our results demonstrate sustained reduction in BMI and weight, reduction in medication burden and temporary reduction in HbA1c in patients with T2DM undertaking a VLCD in the real-world setting

The impact of lockdown and changes in clinical practice on glycemic control during the COVID-19 pandemic: Analysis of data from the National Diabetes Center, Doha, Qatar

Introduction: The coronavirus disease-2019 (COVID-19) pandemic was associated with international obligations that modified lifestyles and clinical practice. These changes are worrisome for patients with diabetes, as disruption from a routine can have devastating effects on glucose control. This retrospective study aims to assess the impact of lockdown and the efficacy of the instituted changes in patient management on blood sugar control. Methods: Patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) who received management through telemedicine at the National Diabetes Center over a lockdown period of 3 months were included. The blood investigations that were done for them as part of standard care were reviewed. Results: A total of 509 patients were included. HbA1c slightly decreased in 49.5% of the patients after the lockdown (P = 0.42). Patients who were not hypertensive experienced a significant reduction in HbA1c (adjusted odds ratios [ORa]: 0.59, 95% confidence interval [CI]: 0.39–0.91, P = 0.018) during the lockdown. A significant association between body mass index (BMI) and lower HbA1c level postlockdown was also determined (ORa: 0.95, (95% CI: 0.92–0.98, P = 0.001). A significant HbA1c reduction was only noted in the BMI group of normal weight (mean: 0.46 ± 0.3, P = 0.03). Conclusion: The imposed lockdown due to COVID-19 did not adversely impact the HbA1c level and glycemic control in T1DM and T2DM patients. Inversely, HbA1c improvements were determined in patients with normal weight and blood pressure after the lockdown period.

Clinical decision support systems with team-based care on type 2 diabetes improvement for Medicaid patients: A quality improvement project

BackgroundThe prevalence of clinical inertia, the failure of appropriate treatment intensification in diabetes treatment, is a well-documented worldwide phenomenon. This project addresses the problem of clinical inertia through three interrelated activities, clinical decision support (CDSS), team-based care, and patient engagement in diabetes management. ObjectivesThe purpose of this research is to provide analysis under the State-University Partnership Learning Network regarding the impact of an electronic decision support tool combined with team-based care workflow on provider decision-making and patient outcomes for the treatment of poorly controlled diabetes mellitus (diabetes) among patients receiving Kentucky Medicaid. The objectives of this study are to 1) assess clinical outcomes of type 2 diabetes in the Medicaid population with team-based care using CDSS, 2) evaluate physicians' and pharmacists' experience on CDSS. MethodsThis is a quality improvement project using a mixed-method - longitudinal and control group comparison of outcomes based upon clinical measures and online surveys of providers and pharmacists involved in this project. ResultsPatients treated by providers who changed the treatment regimen to one that either fully or partially followed the recommendation of the CDSS tool had a statistically significant reduction in HbA1c with an average initial HbA1c of 10.1 and the final HbA1c of 8. The online survey of physicians shows that more than 80% of physicians agree the use of CDSS will support improved patient outcomes. The use of a team-based care approach that includes pharmacists in implementing treatment changes was broadly supported by both physicians and pharmacists. ConclusionCDSS combined with team-based care can be effective in reducing HbA1c to targeted therapeutic levels. The use of CDSS provides a way to efficiently assess more than 160 potential frontline drugs and properly accelerate treatment. Consistent with the research literature, the inclusion of pharmacists can play a key role in team-based care to assess treatment alternatives and provide for improvement in outcomes and patient adherence for diabetes. The user surveys show both physicians and pharmacists have a positive attitude toward CDSS.

A systematic review of the use of common behavioural interventions in oral health and diabetes management

There has been a global rise in the prevalence of type 2 diabetes (T2DM) and it is expected to triple by 2030. Periodontal disease is one common complication of T2DM. As a result, there is potential for the use of common behavioural interventions in the management of both oral diseases and T2DM as a single intervention. To investigate the effectiveness of common behavioural interventions in the management of T2DM and oral diseases, and to synthesize the evidence of its effectiveness on both clinical and behavioural outcomes, a systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Data were extracted from MEDLINE, PsycARTICLES, and Web of Science. Only two studies met the preset inclusion criteria for the systematic review. In the intervention arms of both trials, there was a statistically significant reduction in HbA1c; and there were also improvements in glycaemic control, fasting blood glucose, and periodontal health. Although there is evidence in favour of the use of common behavioural interventions in the management of both oral diseases and T2DM, there is a need for more randomized controlled trials (RCTs) to investigate the use of common behavioural interventions using different populations, socioeconomic backgrounds, age groups, as well as provide a long-term follow-up.

Abstract 11649: GLP-1 Receptor Agonists in Heart Failure: Insights From a Cardiometabolic Center of Excellence

Background: Data regarding the use of GLP-1 receptor agonists (GLP-1RA) in patients with established heart failure (HF) remain limited. Methods: We included patients with established HF treated at Cardiometabolic Center (CMC) between January 2019 and December 2020 who had at least two visits and received GLP-1RA. We compared change in outcomes of interest between baseline and last CMC visit. Results: Among 151 HF patients treated with GLP-1RA, 88 had HF with reduced ejection fraction (HFrEF) and 63 had preserved ejection fraction (HFpEF); 92% had type 2 diabetes (T2D), the rest had prediabetes, and 27% were on SGLT-2i at baseline. After a median follow-up of 6.6 (3.7-11) months, 92% of patients remained on GLP-1RA, (64% were also receiving SGLT-2i at last follow up). The median time on GLP-1RA therapy was 5.4 (3-9.7) months with HFrEF, and 6.1 (3.4-11.8) months with HFpEF. We observed reductions in median total daily insulin doses in both HFrEF and HFpEF patients (from 60 to 39 units, and 53 to 31 units, respectively, p&lt;0.001 for both), mean HbA1c (7.7% to 6.9%, p&lt;0.001 and 7.2% to 6.8%, p=0.002 respectively), and mean percent body weight (-6.2% and -7.9% respectively, p&lt;0.001 for both) ( Figure ). Additionally, lower rates of hospitalizations or urgent visits for HF were seen in those with HFrEF [13.6% vs. 34.1% (p&lt;0.001)], and HFpEF [from 15.9% vs. 33.3% (p=0.01)] during follow-up time compared with an equal duration prior to care at CMC (6.3 months with HFrEF, and 6.9 months with HFpEF). GLP-1RA therapy was generally well-tolerated with side effects in 31% of patients (mainly gastrointestinal complaints), but only 6% required drug discontinuation. Three patients stopped GLP-1RA due to cost. Conclusion: GLP-1RA therapy (in combination with SGLT-2i in most patients) was well-tolerated in both HFrEF and HFpEF, and was associated with significant reductions in insulin dose, HbA1c, body weight, and lower risk of hospitalizations or urgent visits for HF after initiation of therapy.

Obstructive sleep apnoea and 12-month weight loss in adults with class 3 obesity attending a multidisciplinary weight management program

BackgroundAlthough there is a strong association between obesity and obstructive sleep apnoea (OSA), the effects of OSA and CPAP therapy on weight loss are less well known. The aim of this study in adults with class 3 obesity attending a multidisciplinary weight management program was to assess the relationship between OSA and CPAP usage, and 12-month weight change.MethodsA retrospective cohort study of all patients commencing an intensive multidisciplinary publicly funded weight management program in Sydney, Australia, between March 2018 and March 2019. OSA was diagnosed using laboratory overnight sleep studies. Demographic and clinical data, and use of CPAP therapy was collected at baseline and 12 months. CPAP use was confirmed if used ≥4 h on average per night on download.ResultsOf the 178 patients who joined the program, 111 (62.4 %) completed 12 months in the program. At baseline, 63.1 % (n=70) of patients had OSA, of whom 54.3 % (n=38) were using CPAP. The non-OSA group had more females compared to the OSA with CPAP group and OSA without CPAP group (90.2 % vs. 57.9 % and 62.5 %, respectively; p=0.003), but there were no significant baseline differences in BMI (50.4±9.3 vs. 52.1±8.7 and 50.3±9.5 kg/m2, respectively; p=0.636). There was significant weight loss across all three groups at 12 months. However, there were no statistically significant differences across groups in the percentage of body weight loss (OSA with CPAP: 6.3±5.6 %, OSA without CPAP: 6.8±6.9 %, non-OSA: 7.2±6.5 %; p=0.844), or the proportion of patients who achieved ≥5 % body weight loss (OSA with CPAP: 57.9 %, OSA without CPAP: 59.4 %, non-OSA: 65.9 %; p=0.743). In patients with T2DM, there was a significant reduction in HbA1c from baseline to 12 months (7.8±1.7 % to 7.3±1.4 %, p=0.03), with no difference between groups (p=0.997).ConclusionsThis multidisciplinary weight management program resulted in significant weight loss at 12 months, regardless of OSA diagnosis or CPAP use in adults with class 3 obesity. Larger studies are needed to further investigate the effects of severity of OSA status and CPAP use in weight management programs. Until completed, this study suggests that the focus should remain on implementing lifestyle changes and weight management regardless of OSA status.

Continuous Blood Glucose Monitoring Outcomes in Veterans With Type 2 Diabetes.

Nearly 25% of patients served in the US Department of Veterans Affairs have been diagnosed with type 2 diabetes mellitus (T2DM). Patients with DM typically monitor their blood glucose using intermittent fingerstick self-testing. Continuous glucose monitoring (CGM) might offer improved disease management. We conducted a retrospective of VA patient records using a pre-post model. Average hemoglobin A1c (HbA1c) values were calculated for the year before and the year after CGM initiation. Our primary objective was to determine change in HbA1c from the year before CGM initiation to the year after. Secondary objectives included changes in blood pressure, weight, and DM-related hospital and clinic visits during the same time frame. Both the total population and the adherent subgroup showed reduction in HbA1c. The complete population showed a HbA1c change of -0.3, and the adherent subgroup had a change of -1.3. The total population had a mean change in weight of -1.9 lb (-0.9 kg), and the adherent subgroup had an average change of -8.0 lb. Average systolic blood pressure changes were -0.1 mm Hg in the total population and +3.3 mm Hg in the adherent subgroup. A decrease in total encounters for DM complications was observed in the total population (-0.3 total encounters per patient) and the adherent subgroup (-0.6 total encounters per patient). CGM did not correspond with clinically significant reductions in HbA1c. However, veterans with increased health care engagement were likely to achieve clinically significant HbA1c improvements. Adherent patients also had more reduction in weight and hospital or clinic visits with CGM compared with the total population.

Real-World Use of Once-Weekly Semaglutide in Diverse Patient Populations With Type 2 Diabetes: Pooled Analysis of Four SURE Studies

Once-weekly semaglutide, a GLP-1 receptor agonist (GLP-1RA) indicated for type 2 diabetes (T2D), has demonstrated significant HbA1c and body weight (BW) reductions in the first four individual SURE studies (Canada, Denmark/Sweden, Switzerland and UK) investigating real-world use of semaglutide. This pooled post hoc analysis of these four SURE studies evaluated use of semaglutide in the overall population and according to various baseline (BL) characteristics. Patients (≥18 years) with T2D and ≥1 documented HbA1c value ≤12 weeks before semaglutide initiation were enrolled. Anti-hyperglycemic drugs were prescribed at the physician’s discretion. Change from BL to end of study (∼30 weeks) in HbA1c and BW are reported in the overall population, and the following BL subgroups: GLP-1RA experience (naïve/switcher [defined as not receiving a GLP-1RA ≤12 weeks prior to semaglutide initiation]); dipeptidyl peptidase-4 inhibitor (DPP-4i) status; HbA1c; BMI and diabetes duration. The full analysis set comprised 1,212 patients. Significant HbA1c (p<0.0001) and BW (p<0.01) reductions were observed with semaglutide in the overall population and all subgroups (Figure). The greatest HbA1c reduction was observed with BL HbA1c >9%, and the smallest with BL HbA1c <7%; the greatest BW reductions were observed with BL BMI ≥35 kg/m2 or in DPP-4i switchers, and the smallest with BL BMI <25 kg/m2. The discontinuation rate in the overall population was 9.5%; no new safety signals were identified. In conclusion, patients initiating semaglutide experienced significant reductions in HbA1c and BW, in the overall population and in subgroups based on various BL characteristics, including switching from another GLP-1RA.

Analysis of Use and Outcomes of the Balance Digital Disease Management Tool for Patients with Type 2 Diabetes.

Management of type 2 diabetes mellitus (T2DM) is a serious medical need for millions of patients and clinicians worldwide. Numerous smartphone apps for T2DM management are available. Due to their global accessibility, computing power and cellular connectivity, the pervasiveness of mobile phones now provide an opportunity for non-invasive Digital Therapeutics that have the potential to manage disease by modifying patient behavior as new modality for disease management and intervention. However, this novel approach has yet to be tested in large clinical studies. The BALANCE clinical study was designed to evaluate mobile phone App usage in a large multi-center clinical trial and its impact on T2DM outcomes. It included a digital aid for the management of, blood glucose, diet, physical activity, and medication adherence. Overall, patient use of the BALANCE-App was low (21% of significant patients users), and it diminished over time. BALANCE showed no effect on HbA1c or weight, what is consistent with other smartphone apps for T2DM which were tested on large clinical trials. Nevertheless, post-hoc subgroup analysis showed women using the App significantly achieved a significant reduction in HbA1c and weight.Clinical relevance Suitability of Digital Therapeutics, at least in the form of smartphone apps, for T2DM is under question. The low use indicates need for a strong focus in patient acceptability and patient engagement in the design process.

Comparison of Efficacy and Safety of Sitagliptin and Glimepiride in Treatment of Type 2 Diabetes Mellitus

Objective: To compare the efficacy and safety of sitagliptin and glimepiride in treatment of type 2 diabetes mellitus. Design: It was an observational open comparative study. Study Settings: This study was conducted at Department of Pharmacology over 1 year from March 2017 to March 2018 at DHQ Teaching Hospital, Kohat. Material and Methods: Sixty (60) patients were enrolled in the study meeting the inclusion criteria. Tablet glimipiride 1 mg and sitagliptin 100 mg was used as the treatment option. Patients were randomly divided into two groups: group Glimepiride (30 patients; administered glimepiride 2 mg daily) and group Sitagliptin (30 patients; administered sitagliptin 100 mg daily). If glycemic control was not reached then patient was excluded from the study and given further treatment for benefit of the patient. The samples of blood were taken at 12 weeks visit to test HbA1c level, fating blood sugar (FBG) and post prandial glucose (PPG) level. At the time of follow up patient were evaluated for efficacy, safety and tolerability. All collected data was entered then analysed in SPSS version 19.0. Results: A total of 60 patients were enrolled into the study, with 30 in each group. Mean age in sitagliptin group (A) was 45 years, while that of glimeperide group (B) was 47 years. There were 16 males and 14 females in group A, 18 males and 12 females in group B. We found a significant reduction of HbA1C and BMI in group S taking sitagliptin as compared to glimeperide group. (p&lt;0.05) Reduction in FBS was comparable in both the groups. (p&gt;0.05). Side effects in both the groups mostly included hypoglycemia, and vomiting, nausea and abdominal pain. These side effects were mild and did not need stoppage of medication or resulted in drop outs. Conclusion: Sitagliptin as an adjunct to present monotherapy with metformin showed significant drop out in HbA1c, PPG and FBG values after treatment of 12 weeks and was non inferior to glimepiride. However, no sitagliptin taking patients observed any episodes of hypoglycemia. Also weight loss was observed in sitagliptin group as compared to glimepiride group.. Keywords: Glimepiride, Sitagliptin, Efficacy, Safety, Type 2 Diabetes Mellitus

Glucose Awareness to Motivate and Enable Solutions (GAMES) in diabetes mellitus using flash glucose monitoring: A clinical programme.

This real-world observational clinical programme evaluated short and medium-term effects of intermittent flash glucose monitoring on HbA1c, glycaemic variability and lifestyle behavioural changes. Two first-generation Libre flash glucose monitoring sensors were provided 3-4months apart with a food, activity diary, user evaluation survey and treatment modification after each sensor wear. T-tests were used to compare glucose variables within each sensor (week 1 vs. week 2) and between sensors (1st sensor vs. 2nd sensor). EasyGV software was used to calculate glycaemic variability. From 42 type 1 diabetes and 120 type 2 diabetes participants, there was no statistically significant change in mean HbA1c for participants with type 1 diabetes at 3-4months after the 1st sensor but there was a statistically significant HbA1c reduction for participants with type 2 diabetes [-4mmol/mol (-0.4%), p=0.008], despite no statistically significant differences in carbohydrate intake, exercise frequency and duration. Greater reduction was seen in those with baseline HbA1c> 86mmol/mol (10%) in both type 1 [-12mmol/mol (-1.1%), p=0.009] and type 2 diabetes [-11mmol/mol (-1.0%), p=0.001). Both type 1 and type 2 diabetes showed improvements in Glucose Management Indicator and percentage time-above-range when comparing week 1 versus week 2 of the same sensor. Higher scan frequency resulted in improved glycaemic parameters and certain measures of glycaemic variability. The majority of participants (85%) agreed that flash glucose monitoring is a useful device but only 60% were keen to use it for daily monitoring. Constant feedback from flash glucose monitoring improves glycaemic parameters within the first week of wear. Intermittent use 3-4months apart resulted in greater improvements for those with higher baseline HbA1c.

The effect of structured aerobic exercise on adherence, body mass index, hemoglobin A1c, and quality of life in type 1 and type 2 diabetes mellitus

Introduction Cardiovascular mortality risk is significantly increased by inactivity. Nevertheless, most patients with diabetes fail to achieve the recommended amount of weekly physical activity. Thus, strategies to establish and maintain an active lifestyle are required. Objective The aim of the present study was to examine the effects of a 6-month running program, Diabetes Programme Germany (DPD), on adherence, body mass index (BMI), hemoglobin A1c (HbA1c), and health-related quality of life (HRQOL). Methods/Results A retrospective analysis of 428 participants with type 1 (n = 177) and type 2 diabetes (n = 251) was performed. Adherence at 6 months was 75.5%. For participants who completed the program, there was a reduction in HbA1c of 0.3 ± 1.0% (P ≤ .001) and BMI of 0.7 ± 1.1 kg/m2 (P ≤ .001). The greatest improvements were seen in participants with obesity (−1.3 ± 1.7 kg/m2; P ≤ .001) and with type 2 diabetes and a baseline HbA1c ≥7.5% (−1.4 ± 1.7%, P ≤ .001). In a post-interventional survey (response rate: n = 83), participants reported an above-average physical HRQOL. Mental HRQOL showed no significant difference from other patients with diabetes. Conclusion The program's success was confirmed by a high adherence and significant reductions in BMI and HbA1c. Furthermore, a positive effect, especially on physical HRQOL, can be assumed.

Effect of Bariatric Surgery on Glycaemic Control in King Fahad Hospital.

Background: Laparoscopic Sleeve Gastrectomy (LSG) is an approved procedure for weight reduction in obese patients. This outcome of weight loss is essential to achieve optimal control in patients with type 2 diabetes mellitus (T2DM).Objectives: This study was designed to evaluate the effect of LSG on glycemic control among a sample of obese patients in Al-Madinah Al-Munawwarah, Saudi Arabia, through assessment of reduction in hemoglobin A1c (HbA1c) associated with weight loss following LSG.Methods: In this cross-sectional study, we studied 102 patients with a body mass index (BMI) of ≥30 kg/m2 and aged ≥18 years who underwent LSG between January 2017 and December 2019. Patient age, characteristics, preoperative and postoperative records of BMI and HbA1c were collected. The data of BMI and HbA1c were analyzed based on baseline and mean postoperative readings with variable postoperative visits after LSG.Results: There was a 30% reduction in BMI and a 26.4% reduction in HbA1c following LSG from baseline in all patients. We noted 44 patients achieved BMI <40kg/m2 with HbA1c <6.5% and 32 patients achieved BMI <40kg/m2 with HbA1c <5.7% within a mean follow-up time of 10 months.Conclusions: Laparoscopic Sleeve Gastrectomy (LSG) has a positive effect on glycemic control in obese patients in short term, evidenced by the significant reduction of weight and HbA1c. Larger longitudinal studies are needed to assess the long-term impact of LSG glycemic control and the related factors associated with maintaining weight reduction and optimal glycemic control in Saudi Arabia for patients with obesity.

A Systematic Review to Assess the Impact of Hyperbaric Oxygen Therapy on Glycaemia in People with Diabetes Mellitus.

Background and Objectives: Hyperbaric oxygen is a recognised treatment for a range of medical conditions, including treatment of diabetic foot disease. A number of studies have reported an impact of hyperbaric oxygen treatment on glycaemic control in patients undergoing treatment for diabetic foot disease. There has been no systematic review considering the impact of hyperbaric oxygen on glycaemia in people with diabetes. Materials and Methods: A prospectively PROSPERO-registered (PROSPERO registration: CRD42021255528) systematic review of eligible studies published in English in the PUBMED, MEDLINE, and EMBASE databases, based on the following search terms: hyperbaric oxygen therapy, HBO2, hyperbaric oxygenation, glycaemic control, diabetes, diabetes Mellitus, diabetic, HbA1c. Data extraction to pre-determined piloted data collection form, with individual assessment of bias. Results: In total, 10 eligible publications were identified after screening. Of these, six articles reported a statistically significant reduction in blood glucose from hyperbaric oxygen treatment, while two articles reported a statistically significant increase in peripheral insulin sensitivity. Two articles also identified a statistically significant reduction in HbA1c following hyperbaric oxygen treatment. Conclusions: There is emerging evidence suggesting a reduction in glycaemia following hyperbaric oxygen treatment in patients with diabetes mellitus, but the existing studies are in relatively small cohorts and potentially underpowered. Additional large prospective clinical trials are required to understand the precise impact of hyperbaric oxygen treatment on glycaemia for people with diabetes mellitus.