Target HbA1c Value Research Articles

Real-world Safety and Effectiveness of Insulin Glargine 300 U/mL in Participants with Type 2 Diabetes Mellitus During the Period of Ramadan in Four Countries (Egypt, Jordan, Lebanon, and Turkey): A Prospective Observational Study.

This non-interventional observational study aimed to describe the clinical outcomes of patients with T2DM treated with Gla-300 during the period of Ramadan. Type 2 diabetes mellitus (T2DM) patients who decide to fast during the holy month of Ramadan face several challenges in achieving glycemic control without increasing the risk of hypoglycemia. Insulin glargine-300 (Gla-300) has well-established safety and efficacy in improving glycemic control in multiple randomized clinical trials (RCTs). However, limited evidence is available regarding its safety and effectiveness during fasting. The objective of this study was to assess the safety and clinical outcomes of insulin glargine-300 (Gla-300) in T2DM patients before, during, and after Ramadan. We conducted a prospective, observational, non-comparative, multicenter study on patients with T2DM currently treated with Gla-300 who planned to fast and continue on Gla-300 during Ramadan in four countries (Egypt, Jordan, Lebanon, and Turkey). The study outcomes included the change in glycemic parameters and incidence of hypoglycemia before, during, and after Ramadan. One hundred and forty T2DM patients were included. Nearly 61% of the included patients had a duration of diabetes of <10 years. The mean Gla-300 daily doses during the pre-Ramadan, Ramadan, and post-Ramadan periods were 22.2 ±7.4, 20.4 ±7.5, and 22.5 ±4.7 IU, respectively. The mean change values from pre-Ramadan to Ramadan and post-Ramadan were -1.7 ±6.9 IU and 0.5 ±4.7 IU, respectively, among the included patients. The mean HbA1c decreased during the study period initiating from 7.9% ±1.4% pre-Ramadan to 6.9% ±0.4% post-Ramadan. The overall HBA1c target value was 6.9% ±0.4%, while the HbA1c target was achieved by 29 patients (21.9%). The mean fasting blood glucose (FPG) showed a reduction from baseline value in the post-Ramadan period by -0.9 ±2.3 mmol/L. Five patients (3.57%) had symptomatic documented hypoglycemia during Ramadan, and none was considered to have severe hypoglycemia. Our study showed that insulin Gla-300 maintained the glycemic control of T2DM patients who decided to fast during the holy month of Ramadan without increasing the risk of hypoglycemia. Regular self-monitoring of blood glucose levels during Ramadan is highly recommended to avoid possible complications.

Clinical Effects of a Home Care Pilot Program for Patients with Type 1 Diabetes Mellitus: A Retrospective Cohort Study.

Given the importance of continuous self-care for people with type 1 diabetes mellitus (T1DM), the Ministry of Health and Welfare of Korea launched a pilot program for chronic disease management. Herein, we applied a home care pilot program to people with T1DM to investigate its effects. This retrospective cohort study was conducted at a single tertiary hospital (January 2019 to October 2021). A multidisciplinary team comprising doctors, nurses, and clinical nutritionists provided specialized education and periodically assessed patients' health status through phone calls or text messages. A linear mixed model adjusting for age, sex, and body mass index was used to analyze the glycemic control changes before and after implementing the program between the intervention and control groups. Among 408 people with T1DM, 196 were enrolled in the intervention group and 212 in the control group. The reduction in glycosylated hemoglobin (HbA1c) after the program was significantly greater in the intervention group than in the control group (estimated marginal mean, -0.57% vs. -0.23%, P=0.008); the same trend was confirmed for glycoalbumin (GA) (-3.2% vs. -0.39%, P<0.001). More patients achieved the target values of HbA1c (<7.0%) and GA (<20%) in the intervention group than in the control group at the 9-month follow-up (34.5% vs. 19.6% and 46.7% vs. 28.0%, respectively). The home care program for T1DM was clinically effective in improving glycemic control and may provide an efficient care option for people with T1DM, and positive outcomes are expected to expand the program to include more patients.

Effect of glycated hemoglobin on the recurrence rate of paroxysmal atrial fibrillation in patients with type 2 diabetes mellitus who used different glucose-lowering agents

Objective. To evaluate the effects of glycated hemoglobin (HbA1c) levels during different glycemic control regimens on the occurrence of paroxysmal atrial fibrillation (AF) episodes in patients with concurrent type 2 diabetes mellitus (DM) (T2DM). Subjects and methods. The randomized prospective open-label study involved 73 patients (41 males and 32 females; their mean age was 61.4±10.5 years) with paroxysmal AF and T2DM. According to the prescribed therapy, the patients were divided into groups: Group 1 included 39 patients who received combination therapy with dapagliflozin (at a dose of 10 mg/day) and metformin; Group 2 consisted of 34 patients who took sulfonyl urea agents and metformin. The groups were matched for the main clinical and laboratory parameters. Results. At a HbA1c level of 6.5–7.0%, the patients had significantly less frequently episodes of AF in both groups compared to those having an HbA1c 7.0– 7.5% (30.4% versus 77.8%). After treatment, episodes of AF were significantly less frequently seen in Group 1 than in Group 2 (33.3% versus 58.8%; р&lt;0.05). Conclusion. It is desirable to achieve target HbA1C values of 6.5–7.0% (in the absence of contraindications) in patients with paroxysmal AF concurrent with T2DM during sugar-lowering therapy. It is recommended that sugar-lowering agents, such as dapagliflozin, with an organ-protective potential, should be used.

Monocyte response in myocardial infarction in patients with type 2 diabetes

Aim. To reveal the features of monocyte response in myocardial infarction (MI) in pa­­tients with type 2 diabetes (T2D).Material and methods. The study included 121 patients with MI and T2D as follows: 76 — with target glycated hemoglobin (HbA1c), 45 — with elevated HbA1c values. In addition to the standard examination, all patients underwent a blood test for HbA1c on day 1 of MI, while on days 1, 3, 5, and 12±1, monocyte subpopulations were assessed by flow cytometry.Results. Patients with target HbA1c were older than patients with elevated HbA1c levels. In the group with target HbA1c, the number of CD16(+) monocytes on the 1st day of MI was significantly higher: 61,38 (39,2; 100,08) cells/µl vs 35,7 (28,98; 40,33) cells/µl, p=0,03; on the 3rd day of MI, the number of "intermediate" CD14(+)CD16(+) monocytes was higher: 74,82 (71,78; 83,2) cells/µl vs 25,90 (14,04; 57,12) cells/µl, p=0,03, while the CD16(-) to CD16(+) monocyte ratio on the 3rd day of MI was lower: 8,32 (6 ,87; 10,03) vs 10,81 (8,90; 21,10), p=0,04. At the same time, in the group of patients with target HbA1c values, the level of CD16(+) monocytes on the 3rd day of MI was significantly higher in patients aged &lt;71 years compared with patients ≥71 years: 104,55 (63,64; 149,7) cells/µl vs 55,20 (36,92; 76,59) cells/µl, p=0,03.Conclusion. In patients with T2D and target HbA1c values, compared with patients with elevated HbA1c, the inflammatory response in MI is associated with higher levels of CD16(+) monocytes on days 1 and 3 of MI, which is more typical for people aged &lt;71 years.

Prevalence of hypoglycemic conditions in adolescents with type 1 diabetes mellitus in real clinical practice

BACKGROUND. Hypoglycemia and fear of hypoglycemia remain critical problems in the treatment of adolescents with type 1 diabetes mellitus (DM1) and are factors limiting proper control of glycemia and preventing the achievement of metabolic compensation of the disease. The use of pump insulin therapy involves the prevention of hypoglycemic conditions.AIM. To analyze the frequency and duration of hypoglycemia episodes, their effect on the metabolic compensation of the disease in adolescents with type 1 diabetes mellitus (DM1) in real clinical practice, depending on the mode/method of insulin administration.MATERIALS AND METHODS. The study involved 117 adolescents with DM1 aged 12 to 19 years (average age 15.5 years). 37 adolescents received therapy by continuous subcutaneous insulin infusion (CSII); 80 adolescents received therapy by multiple insulin injections (MII). The level of glycated hemoglobin (HbA1c) was determined for all adolescents, and its main indicators were evaluated using a 6 days continuous glucose monitoring (CGM) by the «blind» method of a professional system with an iPro 2 sensor (Medtronic MiniMed, USA).RESULTS. Episodes of a decrease in glucose levels &lt;3,9 mmol/l were recorded in 87% of patients (n=102), 63% (n=74) showed a decrease in glucose levels &lt;3,0 mmol/l. Episodes decrease in glucose levels &lt;3,9 mmol/l at night were recorded in 68% of patients (n=80), and with glucose levels &lt;3,9 mmol/l in 46% (n=54). The frequency of episodes of glucose lowering &lt;3,9 mmol/l had no statistically significant differences depending on the methods of insulin administration (by continuous subcutaneous insulin infusion or multiple insulin injections), however, they are more common in adolescents with HbA1c &lt;7,0% (p=0,03). The median time spent by patients in the range of &lt;3,9 mmol/l was 5% per day, and a longer time in this range was observed in patients with HbA1c &lt;7,0% (p=0,006). The median time in the range of &lt;3,0 mmol/l was 1% per day and had no significant differences depending on the level of HbA1c (p=0,559). There were also no significant differences depending on the groups using CSII and MII (p=0,640 and p=0,250).CONCLUSION. Episodes of glucose reduction in the range of &lt;3,9 mmol/l according to CGM data are more common in adolescents with HbA1c target values, regardless of the method of insulin administration. Significantly more time in range of &lt;3,9 mmol/l is spent by adolescents with target values of HbA1c i.е. &lt;7,0% compared with HbA1c ≥7,0%, however, in both groups, a large number of patients had time in the range below the target level was higher than recommended values.

Glycated Haemoglobin as an Index of Glycaemic Control: Ethnic Variation among Patients with Type 2 Diabetes Mellitus in a Malaysian Tertiary Hospital

Introduction: Previous studies have revealed ethnic differences in glycated haemoglobin (HbA1c) value at the same glucose concentration. This study aimed to determine ethnic variation in HbA1c as an index of glycaemic control among type 2 diabetes mellitus (T2DM) patients. Methods: This cross-sectional, retrospective study recruited 293 T2DM patients by simple random sampling at the medical outpatient clinic of a tertiary hospital. Results: Ethnicity was equally distributed with 33.4% Malays and Indians, respectively, and 33.1% Chinese. Significant difference in ethnicity was noted between HbA1c groups ≤6.5% and &gt;6.5%. Indians had the highest median HbA1c (8.3%), followed by Malays (7.7%) and Chinese (7.2%) [p=0.004]. Malays had lower HbA1c compared with Chinese at lower fasting plasma glucose (FPG) whereas Chinese had lower HbA1c compared with Malays at higher FPG, crossing over at FPG 2.8 mmol/L. Indians had higher HbA1c compared with Chinese and Malays except at FPG cross-over of 16 mmol/L where Malays were higher than Indians. FPG and ethnicity were independent predictors of HbA1c. An increase of 1 mmol/L in FPG resulted in an increase of 0.44% in HbA1c. Indians and Malays had 0.60% and 0.47% higher HbA1c, respectively, than Chinese. Conclusion: This pilot study in Malaysia examined ethnic variation in the relationship between FPG and HbA1c among T2DM patients. Since HbA1c is higher in Indians and Malays compared with Chinese at any given FPG, the hypoglycaemia risk may be increased in Indians and Malays when treatment strategies are focussed on using similar target HbA1c values to treat them.

A Smartphone-Based Application to Assist Insulin Titration in Patients Undergoing Basal Insulin-Supported Oral Antidiabetic Treatment.

INSULIA is an insulin-titration app developed for patients with type 2 diabetes treated with basal insulin as part of a basal insulin-supported oral therapy (BOT). The app uses patient-logged fasting blood glucose (FBG) values and a titration plan defined by the treating physician to provide basal insulin dosing recommendations. Physicians use the web portal to monitor their patients' therapy progress and, if necessary, adjust therapy. The aim of this study was to assess the app, specifically its features, handling and impact on diabetes treatment and self-management in Germany. This German retrospective pilot study included physicians (diabetologists, general practitioners, and internists) and patients with type 2 diabetes who either receive or start BOT using the app. Both groups completed group-specific questionnaires between December 2018 and June 2019. Overall, 10 physicians and 34 patients with type 2 diabetes completed their respective questionnaires. Physicians perceived their app-using patients to be more involved and more confident in managing their insulin therapy than patients not using the app. The majority of patients considered the app as a tool that assists with safer insulin treatment. The physicians perceived that due to the app use, FBG and HbA1c target values were achieved more often than patients not using the app and the number and severity of hypoglycemic episodes was reduced. The titration app seems to have a positive impact on BOT patients' FBG and HbA1c target achievement and was highly appreciated by both physicians and patients alike.

Evaluation of type 1 diabetic patients: A single center experience

We evaluated patients diagnosed with type 1 DM who were followed at our clinic by conducting a retrospective chart review. Medical records of a total of 147 patients with type 1 DM (70 females, 77 males) with a mean (±SD) age of 31.2±9.7 years were reviewed retrospectively. The study patients had a mean duration of follow-up of 13.9±9.5 years, mean duration of follow-up of 4±2.6 years at our clinic and a mean HbA1c value of 8.3±2.1%. Microvascular complications were recorded in medical files for 128 patients. There were 48 (37.5%) patients with at least one microvascular complication. Medical records showed that out of 128 patients, 23 (18%) had diabetic neuropathy alone, 4(3%) had diabetic retinopathy alone and 5 (4%) had diabetic nephropathy alone. Ten patients (8%) had both diabetic nephropathy and diabetic retinopathy and 6 (4.7%) patients had all three microvascular complications. No significant difference was observed between patients with or without microvascular complications in terms of HbA1c (HbA1c 8.3% versus 8.1%; p=0.85). A history of diabetic foot ulcer was present in 4 patients in the study sample (4/147=2.7% of all patients).Twenty-two (15%) patients were on insulin pump therapy during follow-up. Insulin pump users had a significantly lower HbA1c value (7.9%) compared to those not using insulin pump (8.5%) (p=0.02). At our clinic, special efforts are being made to ensure type 1 diabetic individuals have regular outpatient examinations. Despite all these measures, our patients are still far from reaching their target HbA1c values, suggesting that we have to do much more help patients achieve their glycemic goals.

Continuous subcutaneous insulin infusion does not correspond with pregnancy outcomes despite better glycemic control as compared to multiple daily injections in type 1 diabetes – Significance of pregnancy planning and prepregnancy HbA1c

ObjectiveThe aim of the study was to compare pregnancy outcomes with glycemic control, total increase in insulin requirement, and body weight gain in the women with Type 1 Diabetes Mellitus (T1DM) using continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Material and methodsThis was a single center retrospective observational study involving 209 pregnant Caucasian women. Among the study participants, 95 subjects were treated with MDI and 114 patients were using CSII therapy. The primary outcomes were pregnancy results, while secondary ones were HbA1c, increase in daily dose of insulin (DDI), and body weight gain. ResultsAt baseline, the CSII users were older (P = 0.0373), they were diagnosed with T1DM at a younger age (P = 0.047), and more often planned pregnancy (P = 0.032). A majority of the women were classified as class D, according to the White classification. Among the CSII users, a significantly higher proportion of the subjects in class B was noted than in the MDI users, with no differences in the proportion of the remaining White classes. Prepregnancy HbA1c was insignificantly lower in the CSII group, however, a significantly higher proportion of the CSII users reached the target value of HbA1c (P = 0.008). A prepregnancy daily dose of insulin (both total and per kg of body weight), body weight, and body mass index (BMI) did not differ between the groups.The 1st and 2nd trimester HbA1c was lower among the CSII users (6.83 ± 1.38 vs 7.52 ± 2.11%, P = 0.01 and 6.17 ± 0.9 vs 6.57 ± 1.12%, P = 0.009, respectively), while the 3rd trimester HbA1c as well as the total change in HbA1c were comparable. Neither DDI and body weight in concecutive trimesters, nor their total gestational increase, differed between the groups.The rate of pregnancy loss, such as abortions, fetal and neonatal death did not differ between the groups. As regards composite pregnancy loss, prepregnancy HbA1c was 8.41%±2.81% among the MDI cohort vs 7.22%±1.31% in the CSII users (P = 0.517). No differences were found in the gestational age at delivery, the mode of delivery, neonatal birth weight, the rate of macrosomy, LGA or SGA. A higher Apgar score was noted among the CSII users (8.63 ± 1.63 vs 8.03 ± 2.49%, P = 0.047), however, the proportion of neonates with an Apgar score lower than 7 points was similar. In the women planning pregnancy, as compared to the subjects who did not, HbA1c was significantly lower in the 1st trimester, together with a significantly higher rate of the women achieving the target HbA1c value during planning as well as in the 1st trimester. In the group of women planning pregnancy, significantly lower 1st trimester HbA1c and composite outcome of pregnancy loss were observed in the CSII users vs the MDI treated women. Lack of pregnancy planning and a high HbA1c level in the 1st trimester were independent predictors of both LGA (OR = 4.99 [95%CI 1.12–21.0], P = 0.033 and OR = 3.02 [95%CI 1.19–7.65], P = 0.019, respectively) and macrosomia (OR = 8.43 [95%CI 1.36–51.93], P = 0.021 and OR = 5.47 [95%CI 1.77–16.87], P = 0.003, respectively). ConclusionsThe course of pregnancy and obstetric outcomes were not dependent on the mode of insulin delivery, but only on pregnancy planning and HbA1c in early pregnancy. Further studies are needed to explore more precise parameters describing both glycemic control in pregnant women as well as perinatal infant well-being.

Continuous Glucose Monitoring in Type 1 Diabetes

Research Article| October 01 2020 Continuous Glucose Monitoring in Type 1 Diabetes AAP Grand Rounds (2020) 44 (4): 40. https://doi.org/10.1542/gr.44-4-40 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Continuous Glucose Monitoring in Type 1 Diabetes. AAP Grand Rounds October 2020; 44 (4): 40. https://doi.org/10.1542/gr.44-4-40 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: continuous glucose monitoring, diabetes mellitus, type 1, glycemic control Source: Laffel LM, L Kanapka LG, Beck RW, et al. Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: a randomized clinical trial. JAMA. 2020; 323(23): 2388– 2396; doi: https://doi.org/10.1001/jama.2020.6940Google Scholar Investigators from multiple institutions conducted a randomized controlled trial assessing the effect of continuous glucose monitoring (CGM) on glycemic control in adolescents and young adults with type 1 diabetes. Participants were 14–24 years old with a duration of diabetes of at least 1 year who had baseline hemoglobin A1c (HbA1c) levels ≥ 7.5% and < 11.0%. At enrollment, study participants were randomized to use CGM or continue with their regular finger stick blood glucose monitoring (BGM). The CGM system included a disposable sensor inserted under the skin that transmitted interstitial glucose levels every 5 minutes to a receiver or smartphone app; twice-daily finger stick glucose levels were required to calibrate the system. Participants were enrolled in the study for 26 weeks. The primary outcome was change in HbA1c level between baseline and week 26. Differences between groups were assessed using longitudinal linear regression. Secondary outcomes included change in HbA1c at 13 weeks and achieving a HbA1c level in the target range (< 7.5% for those < 19 years old and < 7.0% for those ≥ 19 years old) at 26 weeks. Those in the BGM group wore a CGM device during weeks 24–26 (glucose levels were not provided to the participant). Various glycemic control metrics, including mean glucose, time in the target glucose range (70–180 mg/dL), and time with glucose > 180 mg/dL and < 70 mg/dL, for those in the BGM and CGM groups were compared using regression analyses. A total of 153 participants were included in the study, with 74 randomized to CGM and 79 to the BGM group. The mean age of study participants was 17 years, and mean duration of diabetes was 9 years. Mean baseline HbA1c values were 8.9% for both groups. However, at 26 weeks, mean HbA1c values were 8.5% for those in the CGM group and 8.9% for those randomized to BGM (adjusted difference between groups −0.37%; 95% CI, −0.66%, −0.08%; P = .01). There was also a difference in change in HbA1c levels at 13 weeks between groups (mean values 8.4% and 8.9%, respectively, for the CGM and BGM groups; difference 0.50%; 95% CI, −0.79%, −0.21%; P < .001). At week 26, there was no difference between groups in percent of participants who met target HbA1c values (13% CGM, 10% BGM, P = .42). During CGM monitoring for both groups, those in the CGM group had significantly lower mean glucose levels (P = .003), longer time in the target glucose range (P < .001), and less time with glucose > 180 mg/dL (P = .007) or < 70 mg/dL (P = .02). The authors conclude that use of CGM led to small but statistically significant improvements... You do not currently have access to this content.

Birinci basamakta Diyabetes Mellitus’da akılcı ilaç kullanımı

Diabetes mellitus (DM); is a metabolic progressive di-sease with a rapidly increasing prevalence. The most important factors in the treatment of DM is the education of individuals with diabetes and rational drug use. Multiple insulin therapy is started with the diagnosis in type 1 DM (T1DM), oral antidiabetic drugs (OAD) and insulin treatments are initiated together according to the glycemic status in Type 2 DM (T2DM). Problems causing irrational drug use related to OAD in DM; advanced age, multidrug use, complex drug intake program, lack of knowledge, drug-related side effects, and patient disbelief. Problems causing irrational drug use related to insulin; hypoglycemia, lipodystrophy, incorrect injection technique, insufficient and high dose administration. This situation appears as macrovascular and microvascular diseases with not reaching target HbA1c values by causing glycemic dysregulation in DM. The success of the holding of treatment in optimal status with prevention for glycemia and metabolic condition raises the quality of life in patients, prolong the patient’s life expectancy and reduces costs. Doctors and insulin educators raising awareness of rational drug use in the diabetic population ensures that correct the irrational behaviors performed in the diabetic population and adopt appropriate behaviors as a lifestyle. Thus it will improve the educational content given to people with diabetes, help to improve diabetes management and behavioral change, thereby achieving appropriate glycemic goals and increasing secondary rational gains from drugs with treatment.

Exenatide Once Weekly: Effectiveness, Tolerability, and Discontinuation Predictors in a Real-world Setting

PurposeThe goal of this study was to evaluate the effectiveness and safety of exenatide once weekly (EOW) and to determine predictors of treatment response and drug discontinuation in patients with type 2 diabetes mellitus (T2DM) followed up for 18 months in a real-world setting. MethodsThis retrospective cohort study included patients with T2DM who initiated EOW 2 mg between 2014 and 2019 in an outpatient diabetes clinic in Italy. Data were collected at baseline and at follow-up visits (6, 12, and 18 months after EOW). We estimated glycosylated hemoglobin (HbA1c) and body weight mean changes from baseline to follow-up visits and assessed the proportion of patients reaching HbA1c target ≤7% and a 5% weight loss after 12 months of treatment. We then attempted to establish predictors of glycemic and weight response, and compared patient characteristics between subjects who persisted on treatment versus those who discontinued EOW. FindingsOne-hundred eighty-six patients (46.2% male) were included in the study. The mean (SD) age and diabetes duration were 63.2 (8.9) years and 10.7 years (18.3), respectively. Significant reductions in HbA1c values (−0.9%; 95% CI, −1.1 to −0.8) and body weight (−2.8 kg; 95% CI, −3.4 to −2.2) were observed after 6 months. Sixty-one percent of patients (87 of 143) achieved target HbA1c values ≤ 7% after 12 months, and 34% (45 of 134) exhibited a weight loss of at least 5% of baseline body weight. Blood glucose and weight reductions were maintained after an 18-month follow-up. Predictors of adequate glycemic and weight response were shorter diabetes duration and nonuse of a different GLP-1RA, respectively. Patients on sulfonylureas failed to reach metabolic and body weight targets. The most common adverse events were gastrointestinal side effects (7.5%) and injection site reactions (6.4%), followed by headache (1.1%) and allergic reactions (1.1%). Forty-three percent of patients (79 of 186) discontinued EOW. The main reasons for discontinuation were insufficient HbA1c improvement and/or limited weight reduction (19.9%), side effects (16.1%), or patient decision (6.5%). Predictors of discontinuation were higher HbA1c levels at baseline and use of basal insulin therapy before EOW treatment. ImplicationsEOW treatment, in a real-world setting, offers sustained and effective glycemic control and weight loss over 18 months in patients with T2DM. Diabetes duration and basal insulin therapy, however, may affect the outcome of EOW treatment, suggesting that early initiation of EOW could improve glycemic control and reduce the risk of treatment discontinuation.

Economic benefit of using testosterone gel (used externally) in men with diabetes mellitus and testosterone deficiency

BACKGROUND: High prevalence of type 2 diabetes mellitus (T2DM) and its input to the increase of mortality indicate that social and economic value of this disease and financial burden are great. Testosterone replacement therapy (TRT) enhances the effectiveness of T2DM treatment. A research was conducted to assess if Androgel therapy in diabetic men is cost-effective.&#x0D; OBJECTIVES: Defining of economic benefit of adding Androgel to the T2DM treatment in men with testosterone deficiency.&#x0D; MATERIALS AND METHODS: Economic modeling and results of other clinical studies were used in the analysis. A guildeline of The Scottish Intercollegiate Guidelines Network (SIGN) was used for clinical study selection, development of economic modelling and study design, assessment of study quality. The study analyzed clinical effects (fasting morning glycemia, glycosylated hemoglobin, HOMA index) and mortality reduce.&#x0D; RESULTS: It was shown that TRT can help to reduce costs of glycemic control, to increase efficiency in terms of cost-effectiveness analysis. Target HbA1c value can be reached by additional cost of 569.39 roubles for every patient. There is a possible additional income from 454.100 to 8.896.186 rubles though reduced mortality.&#x0D; CONCLUSION: Thus, testosterone replacement therapy was shown as cost effective due to reduced costs. The analysis demonstrated HbA1c target achievement and, as a result, reduction of the T2DM outcomes and reduced mortality. There is a possible additional income from 454.100 to 8.896.186 rubles per year.

The Association of Obesity and Microvascular Complications with Glycemic Control in Patients with Type 2 Diabetes Mellitus.

Introduction:According Type 2 diabetes mellitus is a chronic metabolic disease with a high prevalence characterized by elevated blood glycemic values and with progressive development of micro and macrovascular complications. Glycemia control is a very important factor in the process of „delaying“ the onset of complications by glycated hemoglobin (HbA1c) analysis.Aim:The aim of the study is to determine the association of obesity, microvascular complications with glycemic control in patients with type 2 diabetes.Methods:The study was prospective, involving 105 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska from January 2016 to January 2018. The patients were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was evaluated based on a target HbA1c value of 7%.Results:Out of the 105 patients in the study, 45.8% were male, 54.2% female. The mean age of the patients was 68.3%±10.7 years. The mean HbA1c level was 8.32±1.57%. Of the total number of patients, in 25.7% the HbA1c levels were ≤7.0%, while in 74.3% the HbA1c were ≥7.0% (p<0.001). There were 57.1% of obese patients, of whom 37.0% had HbA1c ≤7.0%, and 64.1% had HbA1c ≥7.0% (p<0.014). Depending on the duration of diabetes, the study found that ≥7.0% HbA1c was more present in patients with an diabetes duration over 20 years (24.4%) compared with those who had had the diabetes for less than 20 years (3.8%) (p<0.037). Microvascular complications were present in 58 patients (55.2%), of which 33.3% had normal HbA1c values, while unregulated glycemia had 62.8% (p<0.008). Retinopathy was present in 40.9%, polyneuropathy 37.1% and nephropathy 32.4% from which the unregulated glycemia (HbA1c ≥7.0%) was present in 39.7% of patients compared to normal glycemic values in 11.1 % of respondents (p<0.006). In 88 patients, certain diseases were present: hypertension in 76.2% of patients, cardiovascular disease 58.0% and hyperlipidemia 35.2%.Conclusion:Glycemia control in obese patients with type 2 diabetes mellitus is important especially for the prevention of serious microvascular complications that significantly affect the quality of life of patients.

Correlation Between Extracutaneous Microvascular Complications and Diabetic Foot Ulcers in Patients with Type 2 Diabetes Mellitus.

Background:Diabetes is a metabolic disease that is taking an epidemic proportion around the world. The occurrence of microvascular complications and diabetic foot ulcer is associated with an increased mortality and morbidity incidence, which is the most serious complication of this disease, which significantly reduce the quality of patient life.Objective.The aim of the study was to determine the correlation of extracutaneous microvascular complications with diabetic foot ulcer in patients with type 2 diabetes.Method.The study was prospective, and included 160 patients with type 2 diabetes. It was conducted at the University Clinical Center of the Republic of Srpska in the period from January 2016 until December 2019. The respondents were adults, of both sexes, suffering from type 2 diabetes, in whom complications of this disease are present. Glycemic control was established based on a target HbA1c value of 7%.Results. Of the 160 patients in the study, 53.8% were men and 46.2% were women. The average age of the patients was 70.11%±10.05 years. Extracutaneous microvascular complications were present in 85 patients (53.1%); of which 30.2% had well-regulated glycemia (HbA1c≤7.0%), while 61.5% (p<0.001) had unregulated glycemia (HbA1c≥7.0). Polyneuropathy was present in 23.3% of patients with HbA1c≤7.0%, while 41.0% of patients had HbA1c≥7.0% (p<0.043). Nephropathy with HbA1c≤7.0% was present in 36.8% of cases compared to patients with HbA1c≥7.0 in whom the prevalence was 36.8% (p<0.004). Out of total, 25.6% had retinopathy with HbA1c≤7.0%, while in 41.9% of patients with HbA1c≥7.0% (p <0.067). Diabetic ulcer foot was present in 13 patients with HbA1c≥7 (11.1%) compared to patients with HbA1c≤7.0% where there was no occurrence of this complication 0.0% (p<0.021). At the same time, 5.6% of patients had a diabetic foot ulcer with polyneuropathy (p=0.010), 4.4% had neuropathy (p=0.058) and 5.6% had retinopathy (p=0.014).Conclusion:The high incidence of extracutaneous microvascular complications and diabetic foot ulcer in patients with type 2 diabetes requires a multidisciplinary approach of medical professionals that includes prevention of risk factors and good regulation of glycemia.

Insulin Glargine U100 Utilization in Patients with Type 2 Diabetes in an Italian Real-World Setting: A Retrospective Study.

Background This study is aimed at estimating the proportion of type 2 diabetes mellitus (T2DM) patients treated with basal insulin (insulin glargine U100) and at evaluating daily insulin dose, treatment pattern, and adherence to treatment of these patients. Methods Data from administrative and laboratory databases of 3 Italian Local Health Units were retrospectively collected and analyzed. All patients with a diagnosis of T2DM between 01/01/2012 and 31/12/2012 were considered, and those with at least a prescription of insulin glargine between 01/01/2013 and 31/12/2014 were included and followed up for one year. For each patient, we evaluated HbA1c levels both at baseline and during the follow-up period and the daily average dose of insulin. Medication adherence was defined by using medication possession ratio (MPR) and reported as proportion of patients with MPR ≥ 80%. Results 7,422 T2DM patients were available for the study. According to the antidiabetic medication prescribed, patients were categorized into four groups: insulin glargine only, insulin glargine plus oral glucose-lowering drugs, insulin glargine plus rapid-acting insulin, and insulin glargine plus DPP-4 inhibitors. Median daily dose of insulin among insulin glargine only patients was higher than in other groups (35 IU vs. 20 IU, p < 0.05), and a higher percentage of them achieved a target HbA1c value of less than 7.0% (53.8% vs. 30%, p < 0.05), and a higher percentage of them achieved a target HbA1c value of less than 7.0% (53.8% vs. 30%, p < 0.05), and a higher percentage of them achieved a target HbA1c value of less than 7.0% (53.8% vs. 30%, Conclusions A large proportion of T2DM patients treated with insulin fail in achieving the glycemic target of HbA1c level < 7%, irrespective of treatment regimen; however, basal insulin only is associated with lower therapeutic unsuccess. Adherence to antidiabetes medications is also suboptimal in these patients and should be addressed to improve long-term outcomes of reducing and preventing microvascular and macrovascular complications.

Pharmacogenetic aspects of vildagliptin treatment in patients with newly diagnosed type 2 diabetes mellitus

Objective: to study a role of the rs5219 polymorphism in KCNJ11 in the formation of the response variability to vildagliptin therapy in patients with newly diagnosed type 2 diabetes mellitus (T2DM).Materials and methods: 48 patients with newly diagnosed T2DM were examined. For all patients vildagliptin in a dose of 50 mg/day was prescribed. If necessary, dose titration was carried out or other glucose-lowering therapy was prescribed for 6 months of observation. Dynamics of the main indicators of glycemic control and body mass index were studied, presence of the rs5219 polymorphism in KCNJ11 gene was also determined.Results: all patients-carriers the T allele had achieved the target values of glycated hemoglobin (HbA1c) in 3 months of vildagliptin monotherapy, compared to patients with wild-type gene who achieved target values of HbA1c in only 44,4% of cases. Increasing the dose to 100 mg/day required 35% of patients with wild-type gene and 17.9% of patients with rs5219 polymorphism. The appointment of a combination of glucose-lowering therapy was necessary in 40% of patients with the wild-type gene and no one with polymorphism.Conclusion: the presence of the polymorphic allele T rs5219 in KCNJ11 gene makes it possible to predict the high efficacy of vildagliptin monotherapy in patients with newly diagnosed T2DM.

5 Conservative treatment for PAD - Risk factor management.

5 Conservative treatment for PAD - Risk factor management.

De-Intensification Of Blood Glucose Lowering Medication In People Identified As Being Over-Treated: A Mixed Methods Study.

AimTo evaluate if, one year after notification of possible overtreatment, diabetes care providers de-intensified glucose-lowering medications and to gain insight into the opinions and beliefs of both care providers and patients regarding de-intensification.MethodsMixed methods using routine care data from five health-care centres in the Netherlands. Patient characteristics and medication prescription of patients, previously identified as possibly over-treated, were extracted from patients’ medical records. Opinions of care providers were obtained through interviews. Patients received questionnaires about their diabetes treatment and were asked to participate in focus groups.ResultsA total of 64 elderly patients with type 2 diabetes were previously identified as possibly over-treated and included; 57.8% male, median age 75 years (IQR=72–82), median diabetes duration 12 years (IQR=8–18). De-intensification was implemented in more than half (n=36) of them. Care providers preferred person-centred care above just setting general HbA1c target values, considering patient characteristics (such as comorbidity) and patient’s preference. Patients valued glucose levels as most important in determining their treatment. Both patients and care providers felt that de-intensification should occur gradually.ConclusionTreatment had been de-intensified in more than half of the patients (56.3%). Insight in reasons for not de-intensifying elderly patients is important since treatment for them can be “person-centred care”. De-intensification is an iterative and time-intensive process.

Assessment of kidney function and associated risk factors among type 2 diabetic patients

Aimdiabetic patients are required for continuous monitoring programs hence continuous assessment of kidney function parameters is crucial. So, we aimed to determine the prevalence of Chronic Kidney Disease (CKD) and abnormal renal parameters, with poorly controlled type 2 diabetes mellitus pateints Materials and methodsA cross-sectional study was carried out at private health care centre. A total of 300 diabetic patients aged 18 years and above attended the clinic from February 2018 to Dec 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using (SPSS, version 23). Resultsout of the 300 diabetes patients recruited 42% of patients with type 2 diabetes had abnormal Creatinine Serum levels and 22.3% had abnormal glomerular filtration rate (GFR). Abnormal albumin urine levels were found in 28.3% and 11.3% had abnormal creatinine in urine. Abnormal Albumin: Creatinine Ratios (Alb/Cr), were found in 23%. Of the total, 77% (n = 231) had normal Alb: Cr Ratio, 20% had risk of nephropathy and 9% had nephropathy. ConclusionCurrent study revealed a high prevalence of abnormal renal parameters in patients with type 2 diabetes Mellitus. This necessitates the need for early and universal screening of renal functions. There is also an urgent demand for measures that target tight glycaemic, Vitamin D level and life style modifications is also required to all diabetic patients to achieve target value of HbA1C ≤ 7.